# Presentation: 342121

## The National Nursing Home Survey Redesign

- Data Users Conference
- July 12, 2004
- Robin E. Remsburg, PhD, APRN, BC
- National Center for Health Statistics

## 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

##    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

## 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

## 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

##            Major Features

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

**Notes:**
Health status----examples of data that could be used to address clinical quality and outcomes
Medical diagnoses, medications received, and recent adverse drug reactions
Frequency and severity of pain, analgesia, pain relief/control
Medical condition, functional status, hospital and ED admissions & reason for admission

## 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)

##     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

## 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)

## Resident Data

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

## Resident Data (cont.)

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

## End-of-life Items

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

## 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

## 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

## NNAS Data 

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

## 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:  866-441-6247 (NCHS)
- Fax: 301-458-4027
- Email: _[nchsquery@cdc.gov](mailto:nchsquery@cdc.gov)_
- To learn more---
- Listserv
- _[http://www.cdc.gov/nchs/about/major/nnhsd/nnhsd.htm](http://www.cdc.gov/nchs/about/major/nnhsd/nnhsd.htm)_
- LTCSB 301-458-4747