1. Extreme SAS® reporting II: Data Compendium and 5 Star Ratings Revisited Louise S. Hadden Abt Associates Inc.

2. Nursing Home Compare

3. Introduction The Nursing Home Compare project delivers updated 5-Star ratings for 15,700+ nursing homes across the United States each month. A number of data sources are used to create the ratings and other information about nursing homes which are published on the Nursing Home Compare website. In addition, personalized “provider previews” are delivered each month, and several ad hoc projects conducted.

4. Introduction This presentation will discuss two other aspects of our processing: Extending the 5-star processing to accommodate several different output formats for different purposes. Creating an annual data Compendium Innovative techniques will be highlighted and pros and cons discussed.

5. Output Formats In addition to the original output files (now provided in SAS format) and provider previews, we now provide: Analytic Reports Helpline Database and Materials Statement of Deficiency (2567) Materials Web-ready Tab-Delimited Output Web-ready XML Output CSV and Microsoft Access Output for Data.Medicare.Gov

6. Output Formats – Analytic Reports Several reports were destined to be viewed and used in Microsoft Excel. PROC EXPORT did not allow for desired formatting. In addition, we use Unicode characters (specifically stars) for the ratings and we were unable to pass any information using ODS ESCAPECHAR style overrides and functions through to the workbooks and worksheets.

7. Output Formats – Analytic Reports ODS destinations provide a partial solution proc print data = composite label style(header) = {font=("Arial",10pt,Bold) just=center vjust=bottom background=lightblue}style(obsheader) = {font=("Arial",10pt,Bold) just=left vjust=bottom background=lightblue} style(data) = {font=("Arial",10pt,Normal) background=grayee}; where state = "&state" ; id provnum / style(header data)={vjust=bottom font_style=italic htmlstyle= "VND.MS- EXCEL.NUMBERFORMAT:@" cellwidth=.75in }; var provname / style(header data)={vjust=bottom just=left cellwidth=3in } ;...

8. Monthly Processing – Analytic Reports

9. Output Formats – Analytic Reports ODS TAGSETS.EXCELXP (XML output) table created using PROC TABULATE. proc tabulate data=composite... ; tables(all={label='All States' s={font=("Helvetica",9pt,Bold)}}*{s={font=("Helvetica",9pt,Bold statename=' '), (all={label='TOTAL N^{super 1}' s={font=("Helvetica",9pt,Bold)}}*{s={font=("Helvetica",9pt,Bold)}}*n=' '*f=comma6.*{s={font=("Helvetica",9pt,Normal) tagattr='format:#,###'}} &clsvar*(n*f=comma5.*{s={font=("Helvetica",9pt,Normal) just=right tagattr='format:#,###'}} pctn *f=6.2*{s={font=("Helvetica",9pt,Normal) just=right tagattr='format:##0.00'}} ) ) / printmiss misstext='0'; keylabel pctn ='%' ;... keyword all / s={font=("Helvetica",9pt,bold) just=left}; format &clsvar starfmt. ; …

10. Output Formats – Analytic Reports

11. A slight problem... Monthly Processing – Analytic Reports We use DDE to “save as” and freeze column and row headers. This process is described in a paper which is referenced in this presentation’s accompanying paper.

12. A helpline is open for a week each month Need to have a Section 508 compliant solution for some outputs An Access data base is provided with all the data provided on the provider previews along with a template to merge the data into that mimics the appearance of the provider preview for any providers who need to view the provider preview with a reader. The access data base also allows Helpline staff to do look-ups if providers have questions. Output Formats – Helpline Materials

13. Nursing homes have to meet certain standards. State governments do health and fire safety and investigate complaints about nursing home care. Inspections take place about once a year, or more frequently in the case of poor performance. Deficiency citations are issued if a nursing home does not meet a standard and recorded on a detailed inspection report, form HCFA-2567. One of the elements of the 2567 is a 32,767 byte long free text field including PII and embedded non-printing characters. Output Formats – Statements of Deficiencies (2567s)

14. CMS publishes 2567s in their entirety on the Nursing Home Compare website. The free text field must be redacted. We run these very large files and the very large text field through a redaction process using Perl regular expressions to replace sensitive information with generic statements in brackets. Output Formats – Statements of Deficiencies (2567s)

16. Tab-delimited output arranged in a XML-like structure is the production delivery mechanism at the current time. The 2567s presented a unique challenge. There is a 32767 record length limit on delimited output files created using PROC EXPORT. Wrote an “old style” data _null_ and put routine using hard-coded hex tabs in between variables with a longer record length. Stripped embedded tabs Used TRANWRD to convert carriage returns and line breaks to HTML code for line breaks Output Formats – Tab-Delimited Output

17. Using the same files produced to output the tab- delimited output, we create XML files. This is currently in the development phase The vendor wished to combine all the separate output files in the same XML format with three exceptions – two files with different structures, and the 2567s, which will continue to be produced in tab-delimited format. Used three different XML maps / schemas Because not all “measures” had all parts in the schema, a routine to strip out empty parts was designed Due to the very large size of the files, the combined file was split into 10 pieces Output Formats – XML Output

18. We provide Nursing Home Compare data files for Data.Medicare.Gov for minimal pre- processing and upload. This task presented a different challenge. Data files were to be constructed as CSV files, except that more descriptive variable / column names were desired and we needed to be able to preserve formatting in variables (provider number, zip code, etc.) PROC EXPORT to CSV would not work for either of these issues. Output Formats – Data.Medicare.Gov

19. ODS TAGSETS.CSV to the rescue – it has a quote by type option. Re-reading the data set in and outputting, replacing variable names with comma delimited text names in row 1 gave us more descriptive column headers. ods csv file=".\outfiles\intermediate\penalties0.csv“ options(quote_by_type="yes"); proc print data=penalties_csv noobs; run; ods csv close; filename in5 ".\outfiles\intermediate\penalties0.csv"; filename out5 ".\outfiles\penalties.csv"; data test; line='"Federal Provider Number",... "Processing Date"'; file out5; if _n_ = 1 then put line; infile in5 dlm='0D'x firstobs=2; input ; put _infile_; run; Output Formats – Data.Medicare.Gov

20. Data Compendium We have produced the ninth (2012) edition of the Centers for Medicare & Medicaid Services’ (CMS) annual Nursing Home Data Compendium. contains figures and tables The graphs and maps were produced using a combination of SAS/GRAPH and SAS SG Procedures tables were produced using PROC REPORT in conjunction with a custom style template. “alt text” descriptions of each graph and map were produced within a SAS program for the purposes of generating a final Section 508 compliant document.

21. Before we generated final tables and figures, we made some overall formatting decisions. Need to be aware that compendium readers might print out color pages in black and white. Wanted to be consistent in our color schemes and to have it be compatible with CMS’s new logo (yellow and dark blue colors). A custom style template was designed and used. Some examples follow. Code is available on request! Data Compendium – Decisions, Decisions

22. Data Compendium – Tabular Output

23. Data Compendium – Maps

25. After: Additional years of data were added, and levels G-L were collapsed to create a more informative figure. Data Compendium – Figures

26. Data Compendium – Section 508 Compliance

27. Data Compendium – Future

28. Two very important aspects of our 5-Star Rating project are delivering and describing the data we process and create each month, which is the very essence of reporting. Reporting on the wealth of data we process with several different destinations and use cases is made easy by SAS. Among the options used are custom style templates, annotate, macro processing, SAS/ACCESS for PC files, Unicode characters and other style functions, style overrides, and ODS tagsets. Your reporting can be greatly enhanced by the use of these tools. Conclusion

29. Robert Allison, Scott Huntley and Cynthia Zender of SAS provide me with help and inspiration in my varied SAS explorations. The author gratefully acknowledges the contributions to the Data Delivery and Compendium tasks in the Nursing Home Compare 5-star project from: Abt Associates Inc.: Christianna Williams, Allison Muma, Alan White, Alrick Edwards, Xin (Calvin) Guan, Patricia Rowan and Michael Plotzke Centers for Medicare and Medicaid Services: Edward Mortimore, Daniel Anderson, Jon Freedlander, Ian Kramer, and Jean Scott. Acknowledgements

30. Your comments and questions are valued and encouraged. Contact the author at: Louise Hadden louise_hadden@abtassoc.com Code samples are available upon request. Contact Information SAS and all other SAS Institute Inc. product or service names are registered trademarks or trademarks of SAS Institute Inc. in the USA and other countries. ® indicates USA registration. Other brand and product names are trademarks of their respective companies.