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

Redesign Timeline
 Began in 2001  Interdepartmental collaborative effort


 Pilot February 2003  Field Test 2004  National Survey August 2004

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



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

Conceptual Model
-Key Personnel -Advance practice RNs -Turnover -Benefits

-Immunization practices -Mechanical Lifts -Permanent assignments -Palliative care

-ED/hospitalizations -Pressure sores -Falls -Adverse Reactions

Major Features
 Computer Assisted Data Collection (CAPI)  Expanded content
 Facility-level
 Facility

and staffing characteristics  Facility practices
 Resident-level
 Health


Major Features
Expanded clinical content  Care episodes


 Linkage to CMS’ Minimum Data Set

 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


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
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:

 To learn more-- Listserv   LTCSB 301-458-4747