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

2. 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

3. 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

4. Process (cont.) 2.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

5. 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

6. Major Features Computer Assisted Data Collection (CAPI) Expanded content  Facility-level  Facility and staffing characteristics  Facility practices  Resident-level  Health status

7. 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)

8. 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

9. 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)

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

11. 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

12. End-of-life Items Initiation of palliative or hospice care Hospice benefit Symptoms Care and treatments

13. 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

14. 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

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

16. 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.govnchsquery@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