National Hospital Care Survey Demonstration Projects: Characteristics of Inpatient and Emergency Department Encounters Among Patients With Any Listed Diagnosis of Alzheimer Disease.

Objective-This report demonstrates the use of National Hospital Care Survey (NHCS) data using Alzheimer disease (AD) as an outcome. Inpatient discharges and emergency room encounters among patients with AD are described to demonstrate the use of NHCS. The capability of NHCS to link across hospital settings and to the National Death Index (NDI) is highlighted. The data are unweighted and are not nationally representative. Methods-This study analyzed inpatient (IP) and emergency department (ED) data from the 83 nonchildren's hospitals in the 2014 NHCS, out of a sample of 581 hospitals that provided Uniform Bill (UB)-04 administrative claims data for both the IP and ED settings. Encounters with any listed diagnosis of AD were identified using an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code. Individual patients who had any encounter during calendar year 2014 were linked across different hospital-based settings during the same year and with NDI to identify deaths in 2014 or 2015. Results-Analyses are presented on IP and ED encounters with any listed diagnosis of AD to highlight the analytical capabilities of NHCS not available in previous surveys. New data elements not available in the National Hospital Discharge Survey (NHCS' predecessor survey) are analyzed, including intensive care use, and diagnostic and therapeutic services received. Linkage across hospital settings (IP and ED) allows for differentiation of patients who were admitted directly as inpatients from those who were admitted as inpatients from the ED, and allows for identification of patients with only an ED encounter. Linkage to NDI allows for analyses of the underlying cause of death for those deaths occurring in 2014 and 2015. Although these data are not nationally representative, NHCS provides unique analytical opportunities to examine health care utilization among patients with AD across settings.

Hospitalization for Total Knee Replacement Among Inpatients Aged 45 and Over: United States, 2000-2010.

In 2010, total knee replacement was the most frequently performed inpatient procedure on adults aged 45 and over. In the 11-year period from 2000 through 2010, an estimated 5.2 million total knee replacements were performed. Adults aged 45 and over comprised 98.1% of those surgeries. This report uses data from the National Hospital Discharge Survey (NHDS) to present trends in the rate of hospitalizations for total knee replacement, mean age at hospitalization, and discharge status for inpatients aged 45 and over from 2000 through 2010.

Hospitalization for total hip replacement among inpatients aged 45 and over: United States, 2000-2010.

　Total hip replacement, in which both the head of the femur and its socket are replaced, is done to restore movement to hips damaged by osteoarthritis, late-stage degenerative bone and cartilage disease, or other injuries and disease (1). The number of total hip replacements is expected to increase over the next few decades (2). National Hospital Discharge Survey (NHDS) data show trends and estimates of the number and rate of total hip replacements and average length of stay among inpatients aged 45 and over.

Prevalence of incontinence among older americans.

Objective - This report presents national estimates of incontinence prevalence in the United States using data source-specific definitions of incontinence among persons aged 65 and over by sociodemographic characteristics during 2007-2010. Methods - Data are from the 2007-2010 National Health and Nutrition Examination Survey (NHANES), the 2010 National Survey of Residential Care Facilities (NSRCF), the 2007 National Home and Hospice Care Survey (NHHCS), and the 2009 Long Term Care Minimum Data Set (MDS). Findings are based on in-home interviews with 2,625 noninstitutionalized respondents (NHANES) and reports provided by designated facility or agency staff members for 6,856 residential care facility (RCF) residents (NSRCF), 3,226 current home health care patients (NHHCS), 3,918 hospice discharges (NHHCS), and 2,416,705 nursing home residents (MDS). Response rates for incontinence questions were 84% among noninstitutionalized persons (NHANES), 98% among RCF residents and home health and hospice care patients (NSRCF and NHHCS), and 99% for nursing home residents (MDS). Results - This is the first report presenting national estimates on incontinence for subpopulations of older persons sampled in the Centers for Disease Control and Prevention's National Center for Health Statistics surveys and the Centers for Medicare and Medicaid Services' Long Term Care Minimum Data Set. Because a different definition of incontinence is used by each data collection system, it is not possible to make data comparisons between them or to summarize results across all surveys. Accordingly, only survey-specific results are presented. Including recent data from all of these data collection systems facilitates a multidimensional picture of incontinence, while underscoring the need for a standardized definition.

Adoption and use of electronic health records and mobile technology by home health and hospice care agencies.

OBJECTIVE: This report presents national estimates on the adoption and use of electronic health records and mobile technology by home health and hospice care agencies, as well as the agency characteristics associated with adoption. METHODS: Estimates are based on data from the 2007 National Home and Hospice Care Survey, conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. RESULTS: In 2007, 28% of home health and hospice care agencies adopted both electronic health records and mobile technology, while slightly over half (54%) adopted neither. Sixteen percent of agencies adopted only electronic health records. Adoption of both technologies was associated with number of patients served and agency type. Agencies that were for-profit or were jointly owned with a hospital were more likely to have adopted neither technology. Among agencies with electronic health records, the most commonly used functionalities were patient demographics and clinical notes. Among agencies with mobile technology, functionalities for the Outcome and Assessment Information Set (OASIS), e-mail, and appointment scheduling were the most commonly used. Similar percentages of agencies with electronic health records or mobile technology used clinical decision support systems, computerized physician order entry, electronic reminders for tests, and viewing of test results.

Physician adoption of electronic health record systems: United States, 2011.

Data from the 2011 Physician Workflow study In 2011, 55% of physicians had adopted an electronic health record (EHR) system. About three-quarters of physicians who have adopted an EHR system reported that their system meets federal "meaningful use" criteria. Eighty-five percent of physicians who have adopted an EHR system reported being somewhat (47%) or very (38%) satisfied with their system. About three-quarters of adopters reported that using their EHR system resulted in enhanced patient care. Nearly one-half of physicians currently without an EHR system plan to purchase or use one already purchased within the next year.

An overview of home health aides: United States, 2007.

OBJECTIVES: This report presents national estimates of home health aides providing assistance in activities of daily living (ADLs) and employed by agencies providing home health and hospice care in 2007. Data are presented on demographics, training, work environment, pay and benefits, use of public benefits, and injuries. METHODS: Estimates are based on data collected in the 2007 National Home Health Aide Survey. Estimates are derived from data collected during telephone interviews with home health aides providing assistance with ADLs and employed by agencies providing home health and hospice care. RESULTS: In the United States in 2007, 160,700 home health and hospice aides provided ADL assistance and were employed by agencies providing home health and hospice care. Most home health aides were female; approximately one-half were white and one-third black. Approximately one-half of aides were at least 35 years old. Two-thirds had an annual family income of less than $40,000. More than 80% received initial training to become a home health aide and more than 90% received continuing education classes in the previous 2 years. Almost three-quarters of aides would definitely become a home health aide again, and slightly more than one-half of aides would definitely take their current job again. The average hourly pay was $10.88 per hour. Almost three-quarters of aides reported that they were offered health insurance by their employers, but almost 19% of aides had no health insurance coverage from any source. More than 1 in 10 aides had had at least one work-related injury in the previous 12 months. CONCLUSIONS: The picture that emerges from this analysis is of a financially vulnerable workforce, but one in which the majority of aides are satisfied with their jobs. The findings may be useful in informing initiatives to train, recruit, and retain these direct care workers.

Complementary and alternative therapies in hospice: The national home and hospice care survey: United States, 2007.

Objective-This report presents national estimates on the provision and use of complementary and alternative therapies (CAT) in hospice. Comparisons of organizational characteristics of hospice care providers are presented by whether the provider offered CAT. Comparisons of selected characteristics of patients discharged from hospice are presented by whether they received care from a provider that offered CAT, and whether they received a CAT service. Methods-Estimates are based on data from the 2007 National Home and Hospice Care Survey (NHHCS), conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. Results-In 2007, 41.8% of hospice care providers offered CAT services, had a CAT provider on staff or under contract, or both. Among hospice care providers offering CAT, over one-half offered massage (71.7%), supportive group therapy (69.0%), music therapy (62.2%), pet therapy (58.6%), or guided imagery or relaxation (52.7%). Of the hospice care providers that offered CAT, 21.5% had at least one discharged hospice patient who received CAT during hospice care. Overall, 4.9% of all discharged hospice patients received at least one CAT from the hospice care provider. Over one-half of discharged patients (56.5%) received care from a provider that offered CAT, and of those, 8.6% received at least one CAT from the hospice care provider during their stays. There were no differences in demographics, health, functional status, or admission diagnoses between patients discharged from hospice either by whether they received care from a provider that offered CAT or whether they received CAT.

Electronic medical record adoption and use in home health and hospice.

In 2007, about 5,900 of the 14,500 providers of home health or hospice care (41%) had electronic medical records (EMRs), and an additional 2,200 (15%) planned to have EMRs within the next year. Providers who offered both hospice and home health care were more likely to have EMRs than providers offering only home health care, but did not differ from providers of hospice care only. Among providers with EMRs, 98% used components for recording patient demographics and 83% for clinical notes, and over one-half used clinical decision support systems or computerized physician order entry. Nonprofit and government providers, providers jointly owned or operated with other health care organizations, and providers with over 150 patients were more likely to have EMRs.

Design and operation of the national home health aide survey: 2007-2008.

OBJECTIVES: This report provides an overview of the National Home Health Aide Survey (NHHAS), the first national probability survey of home health aides. NHHAS was designed to provide national estimates of home health aides who provided assistance in activities of daily living (ADLs) and were directly employed by agencies that provide home health and/or hospice care. This report discusses the need for and objectives of the survey, the design process, the survey methods, and data availability. METHODS NHHAS, a multistage probability sample survey, was conducted as a supplement to the 2007 National Home and Hospice Care Survey (NHHCS). Agencies providing home health and/or hospice care were sampled, and then aides employed by these agencies were sampled and interviewed by telephone. Survey topics included recruitment, training, job history, family life, client relations, work-related injuries, and demographics. NHHAS was virtually identical to the 2004 National Nursing Assistant Survey of certified nursing assistants employed in sampled nursing homes with minor changes to account for differences in workplace environment and responsibilities. RESULTS From September 2007 to April 2008, interviews were completed with 3,416 aides. A public-use data file that contains the interview responses, sampling weights, and design variables is available. The NHHAS overall response rate weighted by the inverse of the probability of selection was 41 percent. This rate is the product of the weighted first-stage agency response rate of 57 percent (i.e., weighted response rate of 59 percent for agency participation in NHHCS times the weighted response rate of 97 percent for agencies participating in NHHCS that also participated in NHHAS) and the weighted second-stage aide response rate of 72 percent to NHHAS.

Prevalence and management of pain, by race and dementia among nursing home residents: United States, 2004.

KEY FINDINGS: Data from the National Nursing Home Survey, 2004. About one-quarter of all nursing home residents reported or showed signs of pain. Nonwhite residents and residents with dementia were less likely to report or show signs of pain compared with white residents and residents without dementia. Nonwhite residents with dementia were least likely, and white residents without dementia were most likely to report or show signs of pain. Forty-four percent of nursing home residents with pain received neither standing orders for pain medication nor special services for pain management (i.e., appropriate pain management). Among residents with dementia and pain, nonwhite residents were more likely than white residents to lack appropriate pain management.

The National Nursing Home Survey: 2004 overview.

OBJECTIVE: This report presents estimates for U.S. nursing homes, their current residents, and staff, based on results from the 2004 National Nursing Home Survey (NNHS). Facility data are summarized by facility characteristics and include new data items on special care units and programs, formal contracts with agencies and providers, end-of-life care programs, and electronic information systems. Current residents are presented by characteristics such as demographics, health and functional status, and services received, with new data items on advance directives, falls, use of restraints, hospitalizations, pain management, and medications. The discussion highlights key survey findings, including differences in selected national estimates between the 2004 NNHS and the 1999 survey. METHODS: The 2004 NNHS consisted of a two-stage design with a probability sample of 1,500 nursing facilities in the first stage and up to 12 current residents from each facility in the second stage. This nationally representative sample survey was conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics from August 2004 through January 2005. RESULTS: In 2004, an estimated 1.5 million current residents received nursing home care in 16,100 facilities, the majority of which were proprietary (61.5%) and were located in the Midwest and in the South. Most full-time equivalent employees of the facilities were nursing staff. Most current residents were aged 65 years and older (88.3%), female (71.2%), and white (85.5%). Nearly one-half (48.2%) of all residents were admitted from a hospital or health care facility other than a nursing home or assisted-living-type facility, and 65.3% of all residents had some kind of advance directive.

Demographic and social characteristics and spending at the end of life.

In the United States and abroad, the aging of the population and changes in its demographic and social composition raise important considerations for the future of health care and the systems that pay for care. Studies in the United States on end-of-life expenditures and utilization focus primarily on Medicare and have reported differences in formal end-of-life spending and types of services used by age, race, gender, and other personal characteristics, with most notable differences attributed to age at death. Although overall health care spending tends to be higher for people who are white and women, these patterns tend to either reverse themselves or narrow at the end of life. However, age at death continues to be associated with large spending differences at the end of life, with end-of-life spending declining at older ages. Although different data sources, analytic methods, and definitions of end-of-life care make comparisons of the absolute level of end-of-life spending in the United States to that of other countries difficult, a reading of the existing literature reveals some similarities in the distribution of spending across patient characteristics, even across different systems of health care and insurance. In particular, end-of-life spending tends to decline with age, indicating that treatment intensity likely declines with age in most countries to varying degrees. Future international collaborations may help to make data collection and analysis efforts more comparable, enabling identification of factors associated with high-quality end-of-life care and helping health care planners across countries to learn from the successes of others.

Intrinsic job satisfaction, overall satisfaction, and intention to leave the job among nursing assistants in nursing homes.

PURPOSE: We examined predictors of intrinsic job satisfaction, overall satisfaction, and intention to leave the job among nursing assistants (NAs). DESIGN AND METHODS: The study focused on NAs who worked 30 or more hours per week in a nursing home. Data on 2,146 NAs meeting this criterion came from the 2004 National Nursing Assistant Survey, the first telephone interview survey of NAs nationwide. Regression equations were calculated in which intrinsic satisfaction, overall satisfaction, and intention to leave were dependent variables. NA attributes (e.g., job tenure and education) and extrinsic job factors (e.g., assessment of supervisor behavior, pay satisfaction, and benefits) were exogenous variables. RESULTS: A positive assessment of the supervisor's behavior had the strongest association with intrinsic satisfaction. Pay satisfaction had the second strongest association with intrinsic satisfaction. Predictors with the strongest associations with intention to leave were overall and intrinsic satisfaction. Assessment of the supervisor was not associated directly with intention to leave. Assessments of the supervisor and pay may affect overall satisfaction and intention to leave in part through their direct effects on intrinsic satisfaction. Some facility and NA attributes were related to intrinsic satisfaction but not to overall satisfaction, suggesting that intrinsic satisfaction may be an intervening variable in the impact of these attributes on overall satisfaction. IMPLICATIONS: Intrinsic satisfaction and extrinsic job factors amenable to change appear central to NAs' overall satisfaction and intention to leave. A facility may be able to improve extrinsic job factors that improve NAs' job-related affects, including intrinsic satisfaction.

The National Nursing Assistant Survey: improving the evidence base for policy initiatives to strengthen the certified nursing assistant workforce.

PURPOSE: This study introduces the first National Nursing Assistant Survey (NNAS), a major advance in the data available about certified nursing assistants (CNAs) and a rich resource for evidence-based policy, practice, and applied research initiatives. We highlight potential uses of this new survey using select population estimates as examples of how the NNAS can be used to inform new policy directions. DESIGN AND METHODS: The NNAS is a nationally representative survey of 3,017 CNAs working in nursing homes, who were interviewed by phone in 2004-2005. Key survey components are recruitment; education; training and licensure; job history; family life; management and supervision; client relations; organizational commitment and job satisfaction; workplace environment; work-related injuries; and demographics. RESULTS: One in three CNAs received some kind of means-tested public assistance. More than half of CNAs incurred at least 1 work-related injury within the past year and almost one quarter were unable to work for at least 1 day due to the injury. Forty-two percent of uninsured CNAs cite not participating in their employer-sponsored insurance plan because they could not afford the plan. Years of experience do not translate into higher wages; CNAs with 10 or more years of experience averaged just $2/hr more than aides who started working in the field less than 1 year ago. IMPLICATIONS: This survey can be used to understand CNA workforce issues and challenges and to plan for sustainable solutions to stabilize this workforce. The NNAS can be linked to other existing data sets to examine more comprehensive and complex relationships among CNA, facility, resident, and community characteristics, thereby expanding its usefulness.

End-of-life care in nursing homes: 2004 National Nursing Home Survey.

OBJECTIVES: This report presents information on nursing home residents receiving end-of-life (EOL) care in nursing homes. Residents receiving EOL care are compared with those not receiving EOL care on demographics, functional and cognitive status, reported pain, medications, and diagnoses. Residents receiving EOL care are further categorized by whether they started EOL care on or prior to admission to the nursing home or after admission to the nursing home. These two groups receiving EOL care are compared with each other on demographics, functional and cognitive status, medications, diagnoses, length of time receiving EOL care, and treatments received. METHODS: Data are from the resident component of the 2004 National Nursing Home Survey (NNHS). The 2004 NNHS is a nationally representative, cross-sectional probability sample survey of all current residents in nursing homes in the United States with three or more beds and either certified by Medicare or Medicaid or licensed by the state. All information is derived from interviews with nursing home staff. RESULTS: Nursing home residents receiving EOL care were older, more functionally and cognitively impaired, and more likely to have reported pain in the previous 7 days compared with nursing home residents not receiving EOL care. They were also more likely to have at least one advance directive. Three-fourths of residents who received EOL care in the nursing home started EOL care after admission to the nursing home. Differences in age, functional impairment, and cognitive impairment were observed among residents receiving EOL care depending on when they started EOL care. However, no differences in services and treatments received were observed depending on whether EOL care started on or prior to admission or after admission to the nursing home. The mean length of time on EOL care was approximately 5 months and did not differ by whether the care started on or prior to admission or after admission to the nursing home.

An introduction to the National Nursing Assistant Survey.

OBJECTIVES: This report provides an introduction and overview of the National Nursing Assistant Survey (NNAS),the first national probability survey of nursing assistants working in nursing homes. The NNAS was designed to provide national estimates and to allow for separate estimates to be calculated for nursing assistants by geographic location of the agency and for workers by tenure at the sampled facility. This report includes a description of relevant research that led to federal interest in sponsoring the NNAS, types of data collected, methodology, linkage between the NNAS and the 2004 National Nursing Home Survey (NNHS), advantages of combining establishment and worker surveys, and potential uses of the data. METHODS: The NNAS was conducted as a supplement to the 2004 National Nursing Home Survey. The design was a stratified, multistage probability survey. Nursing facilities were sampled and then nursing assistants were sampled within the facilities. Telephone interviews were conducted with nursing assistants using Computer-Assisted Telephone Interviews (CATI). The survey instrument consisted of sections on recruitment, training and licensure, job history, family life, management and supervision, client relations, organizational commitment and job satisfaction, workplace environment, work-related injuries, and demographics. RESULTS AND CONCLUSIONS: A total of 3,017 interviews were completed from September 2004 to February 2005. The overall response rate was 53.4 percent. A public-use data file has been released that contains the interview responses and sampling weights. The file also includes ownership, bed size, and geographic location of the facility where the nursing assistant was sampled. Estimates based on the sampling weights can be used to produce national estimates.

Use of computerized medical records in home health and hospice agencies: United States, 2000.

OBJECTIVE: The use of information technology (IT), such as computerized medical records (CMR), has been proposed as a method for increasing the efficiency of delivered services, raising the level of the quality of care provided, and decreasing the number of medical errors. Research on IT and CMRs in health care has focused primarily on hospitals and physicians' offices, and there currently exists no nationally representative information for home health and hospice agencies. This report provides the first nationally representative estimates of the prevalence of CMR use in home health and hospice agencies in the United States in 2000. METHODS: Data are from the 2000 National Home and Hospice Care Survey. Data presented include estimates of home health and hospice agencies that are currently using or planning to use a CMR in the next year. CMR use is also presented by agency characteristics. RESULTS AND CONCLUSIONS: Approximately 32% of all agencies were using a CMR. Nearly one-third of home health agencies (32.1%), one-fifth of hospice agencies (18.6%), and two-fifths of mixed-type agencies (offering both services) (40.3%) reported using a CMR. Number of current active patients and provision of "high technology" services (e.g., respiratory, intravenous, or enterostomal therapy) were significantly associated with use of CMRs. While 23.0% of agencies with 50 or fewer patients reported use of a CMR, the proportion almost doubled to 44.8%, among agencies with 100 or more patients. Over one-third (34.8%) of agencies that provided high technology services reported using a CMR, compared with one-fifth (20.8%) of agencies that did not provide high technology services. No other agency characteristics were found to have a significant relationship with CMR use.

Pilot testing of the Restorative Care Intervention: impact on residents.

The purpose of this pilot study was to test the feasibility and effectiveness of a two-tiered motivational intervention, the Res-Care Intervention, on nursing home residents. Twenty-one residents consented to participate in the study. The residents were 88.3 (+/- 4.9) years of age, had lived in the facility 1.6 (+/- 3.4) years, were women (93%), White (93%), and unmarried (85%). Although there were some positiv trends, there was not a statistically significant difference in any of the resident outcomes following implementation of the Res-Care Intervention. The findings have been used to revise the Res-Care Intervention to include additional education needs for the nursing assistants, revisions in the motivational intervention for the nursing assistants and nurses, clarification of documentation and motivational techniques to improve documentation, and implementation of a more comprehensive treatment fidelity plan.

Making a difference: nursing assistants' perspectives of restorative care nursing.

This article explores the experiences of nursing assistants who participated in the Res-Care Pilot Intervention. A qualitative study used a focus group methodology. An interview guide was used and data from focus groups were audiotaped and transcribed verbatim. A purposive sample of 13 nursing assistants participated in the focus groups. A total of 35 different codes were identified, and these were reduced to the following four themes: resident barriers to restorative care, facility or system barriers to restorative care, nursing assistant strategies, and system facilitators of restorative care. The study supports and adds to previous work that suggests that in order to successfully implement changes in care in nursing home settings the following issues should be addressed: real or perceived workload issues, poor communication with nursing, insufficient knowledge or education, lack of appropriate supplies, and insufficient administrative support. The findings may be used to revise the Res-Care Pilot Intervention and direct future implementation of programs in nursing home settings.