The National Nursing Home Survey Redesign

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The National Nursing Home Survey Redesign
Data Users Conference July 12, 2004 Robin E.
Remsburg, PhD, APRN, BC National Center for
Health Statistics
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Redesign Timeline

• Began in 2001
• Interdepartmental collaborative effort
• CDC, NCHS, AHRQ, OASPE, CMS, FDA, Dept. of VA
• Pilot February 2003
• Field Test 2004
• National Survey August 2004

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Process

• 1. Identify important policy/practice issues
• Review Future Directions for Residential LTC
• Health Services Research (October 1999)
• Future Directions for Community-based LTC Health
  Services Research (June 2000)
• IOM report from the Committee on Improving
  Quality in LTC (IOM, 2001).
• Policy questions
• Characteristics of nursing homes residents
• Care and services provided by nursing homes
• Cost/reimbursement
• Quality/outcomes

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Process (cont.)

• Identify data gaps
• -1999 National Nursing Home Survey (NNHS)
• -1997 Medicare Current Beneficiary Survey (MCBS)
• -Minimum Data Set (MDS)
• -Online Survey Certification and Reporting
• Survey (OSCAR)
• -1996 Medical Expenditures Survey Nursing Home
• Component (MEPS NHC)
• -1999 National Long-term Care Survey
• -Longitudinal Studies of Aging

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Conceptual Model

• Structure Process Outcomes
• -Key Personnel -Immunization practices
  -ED/hospitalizations
• -Advance practice RNs -Mechanical Lifts
  -Pressure sores
• -Turnover -Permanent assignments -Falls
• -Benefits -Palliative care -Adverse
  Reactions

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Major Features

• Computer Assisted Data Collection (CAPI)
• Expanded content
• Facility-level
• Facility and staffing characteristics
• Facility practices
• Resident-level
• Health status

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Major Features (cont.)

• Linkage to CMS Minimum Data Set
• Expanded clinical content
• Care episodes
• New sample design
• Expanded sample
• Flexibility to accommodate future revisions
• National Nursing Assistant Survey (NNAS)

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Facility Data

• Administrators, Medical Directors, Directors of
  Nursing
• -Preparation
• -Years of experience
• -Tenure at the facility
• -Specialty certification
• Nursing Staff
• -FTEs
• -RN mix
• -Specialty certification
• -New roles----MDS nurses, case managers, QI,
  infection control
• -APPNs
• -Entry-level wages
• -Recruitment/retention strategies
• -Benefits
• -Collective bargaining arrangements
• -Staff turnover and stability
• -NA involvement in care planning, use of
  permanent assignments

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Facility Data (cont.)
Miscellaneous Other -Accreditation -Medical
services -Electronic/computerized information
systems -Recreation activities -Dining
practices -Mechanical lifts -Immunization
policies practices -End-of-life practices
(POLST, Last Acts) -Special care programs (e.g.,
wound, dementia)
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Resident Data

• MDS items
• -Advance directives
• -Cognitive skills
• -Mood
• -Behavioral symptoms
• -ADLs
• -Continence
• -Accidents
• -Weight change
• -Nutritional therapy
• -Pressure ulcers
• -Restraints

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Resident Data (cont.)

• New Items
• -Admission to a specialty unit (Alzheimers,
  hospice)
• -Receiving specialty services (Alzheimers,
  hospice)
• -Hospitalizations
• -ED visits
• -Pain assessment, management, relief
• -Medications
• -Recent drug adverse experiences
• -End-of-life care
• -Out of pocket charges

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End-of-life Items

• Initiation of palliative or hospice care
• Hospice benefit
• Symptoms
• Care and treatments

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National Nurse Assistant Survey (NNAS)

• Collaboration with ASPE
• Reduces NNAS costs by utilizing an existing
  sampling frame and data collection methodology
• Enhances response rates and reduces burden
• NNHS survey enhancements increase the analytical
  usefulness of NNAS and NNHS

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NNAS Goals

• Describe characteristics of nurse assistants
• Explore why workers remain in the field and
  determine factors that influence retention
• Understand how these factors affect workers
  attitudes, relationships with managers and
  clients, and job satisfaction

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NNAS Data

• Recruitment
• Education/Training
• Job History
• Family Life
• Management/Supervision
• Client Relations
• Job Satisfaction
• Workplace environment
• Injuries
• Demographics
• Reasons for leaving

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Plans for Dissemination

• Data products
• Reports
• Public use data files
• Access data products
• Downloadable from the Internet
• Data files on CD-ROMS
• NCHS Office of Information Services
• Telephone [phone] (NCHS)
• Fax [phone]
• Email nchsquery_at_cdc.gov
• To learn more---
• Listserv
• http//www.cdc.gov/nchs/about/major/nnhsd/nnhsd.ht
  m
• LTCSB 301-458-4747