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Medicare HOS Publications
The Medicare HOS
Partners and other leading health outcomes experts are involved in research
utilizing Medicare HOS
data. These efforts have resulted in the publication of a number of manuals,
peer-reviewed articles, and technical reports. Research based on the HOS data has
been published in academic peer-reviewed journals such as International Journal
of Geriatric Psychiatry, Health Services Research, Health and Quality of Life Outcomes,
International Journal for Quality in Health Care, Health Care Financing Review,
and Cancer. Topics such as depression, smoking, health disparities, and chronic
illness have been investigated utilizing HOS data. For additional information on
Medicare HOS research, please contact the HOS Information and Technical Support Line.
The following list of publications (manuals, peer-reviewed articles, and technical
reports) has been assembled to provide additional information on the Medicare HOS
and to facilitate the utilization of the
HOS data files produced by the Medicare HOS Program. The publications are
organized into the following categories:
(1) Overview, (2) Methodology, (3) Results,
and (4) Applications/Interventions.
Overview
Peer Reviewed Articles
- Haffer, Samuel C. and Bowen, Sonya E. "Measuring and Improving Health Outcomes
in Medicare: The Medicare HOS Program." Health Care Financing Review.
Summer 2004. Volume 25(4): 1-3. Available online at
CMS' Health Care Financing Review website.
- Jones, Nathaniel, III, Jones, Stephanie L. and Miller, Nancy A.
"The Medicare Health Outcomes Survey program: Overview, context, and near-term
prospects." Health and Quality of Life Outcomes. July 12, 2004. Volume
2(33): Available online at
www.hqlo.com (PDF, 248 KB).
- Cooper, James K., Kohlmann, Thomas, Michael, James, Haffer, Samuel C. and Stevic,
Marcia. "Health Outcomes. New Quality Measure for Medicare." International
Journal for Quality in Health Care. February 2001. Volume 13(1): 9-16.
- Golden, William. "Counterpoint: Integrating Health Status into the Quality
Equation." International Journal for Quality in Health Care. February
2001. Volume 13(1): 5-6.
- Safran, Dana G. "Counterpoint: Measuring, Monitoring and Reporting Functional
Health Outcomes: Opportunities and Challenges in a Bold National Initiative."
International Journal for Quality in Health Care. February 2001. Volume
13(1): 7-8.
- Haffer, Samuel C., Cooper, James K. and Gordon, Catherine. "The Health of Seniors
Project." Managed Care and Aging. American Society on Aging. Volume
5(2).
Technical Reports
- The Medicare Health
Outcomes Survey Evaluation Final Report (PDF, 2.3 MB)
In 2003 and 2004, CMS funded an independent evaluation of the HOS program. The evaluation
encompassed three components: 1) a review of the context for the HOS program; 2)
an evaluation of the HOS instrument and operational protocol; and 3) an assessment
of policy issues related to turning HOS data into useful information for health
plans, QIOs, CMS and health care researchers. This final report summarizes the findings
of the overall evaluation. A brief overview is provided on the measurement of quality
of care and, in particular, the transition from structural and process measures
of care to outcomes of care. Also discussed is the role of quality of care assessment
and improvement within a broader strategy of health plan performance measurement.
Several national initiatives are noted. Further, factors that contributed to the
development of the HOS program are reviewed, followed by a discussion of the HOS
program administration and data utilization.
- 2006 Sample Baseline Report (PDF, 1.4
MB)
After the administration of each baseline cohort, a cohort specific baseline report
is produced. The baseline reports present physical component summary and mental
component summary scores. The scores are case mix adjusted using demographics, chronic
medical conditions, and HOS study design variables. The baseline reports also provide
plan, state, and HOS national information on the Centers for Disease Control and
Prevention (CDC) Healthy Days Measures, the HEDIS Management of Urinary Incontinence
in Older Adults (MUI) Measure, the HEDIS Physical Activity in Older Adults (PAO)
Measure, the HEDIS Fall Risk Management (FRM) Measure, the HEDIS Osteoporosis Testing
in Older Women (OTO) Measure, additional health status indicators, and demographics.
- 2004-2006 Sample Performance Measurement Report (PDF,
1.6 MB)
After the administration of each follow up cohort, a cohort specific performance
measurement report is produced. A performance measurement report data set is created
by merging a cohort's baseline and follow up data. Additionally, death information
is incorporated into the performance measurement data set for those baseline respondents
who died between baseline and follow up. The HOS performance measurement results
are computed using a rigorous case mix/risk adjustment model. Plans are rated on
whether they performed Better than Expected, Same as Expected,
or Worse than Expected on Physical and Mental Health. The performance measurement
reports also provide plan, state, and HOS national information on health status
indicators and demographics.
Methodology
Manuals
- National Committee for Quality Assurance (NCQA). HEDIS®,
Volume 6: Specifications for the Medicare Health Outcomes Survey. Washington
DC: NCQA Publication, 1998 - 2008. NCQA annually publishes the HEDIS®,
Volume 6: Specifications for the Medicare Health Outcomes Survey manual.
The manual contains background information about the survey, the measure description,
the HEDIS® protocol, the English and Spanish versions of the HOS questionnaires,
and the text for the survey letters and postcards. In addition, the appendix contains
a description of how longitudinal health outcomes are analyzed in HOS and a list
of available HOS resource materials. Copies of HEDIS® Volume 6 may
be purchased by calling NCQA Customer Support at (888) 275-7585 or via NCQA's Secure Online
Order Center (www.ncqa.org).
Peer Reviewed Articles
- Hope, MaryAnne DePesquo and Shannon, Erin Dowd "A Comparison
of Two Procedures to Fit Multi-Level Data: PROC GLM versus PROC MIXED." SUGI
30 Proceedings. April 2005. Available online at the SUGI 30 Proceedings web page.
- Gandek, Barbara, Sinclair, Samuel J., Kosinski, Mark and Ware, John E. "Psychometric
Evaluation of the SF-36® Health Survey in Medicare Managed Care."
Health Care Financing Review. Summer 2004. Volume 25(4): 5-25. Available
online at
CMS' Health Care Financing Review website.
- McCall, Nancy, Khatutsky, Galina, Smith, Kevin and Pope, Gregory C. "Estimation
of Non-Response Bias in the Medicare FFS HOS." Health Care Financing Review.
Summer 2004. Volume 25(4): 27-41. Available online at
CMS' Health Care Financing Review website.
- Kazis, Lewis E., Lee, Austin, Spiro, Avron, Rogers, William, Ren, Xinhua S., Miller,
Donald R., Selim, Alfredo, Hamed, Alaa and Haffer, Samuel C. "Measurement Comparisons
of the Medical Outcomes Study and Veterans SF-36® Health Survey."
Health Care Financing Review. Summer 2004. Volume 25(4): 43-58. Available
online at
CMS' Health Care Financing Review website.
- Haffer, Samuel C. "Using Multiple Survey Vendors to Collect Health Outcomes
Information: How Accurate Are the Data?" Health and Quality of Life Outcomes.
April 16, 2003. Volume 1(6): Available online at www.hqlo.com.
- Hwang, Yi-Ting, Bierman, Arlene S., Haffer, Samuel C. and Wun, Lap Min. "Weight
Adjustments in Estimates for the 1999 Medicare Health Outcomes Survey." ASA
Proceedings of the Joint Statistical Meetings. 2002. 1565-1570.
- Ware, John E. and Kosinski, Mark. "Interpreting SF-36® Summary
Health Measures: A Response." Quality of Life Research." 2001.
Volume 10(5): 405-413, 415-420.
Technical Reports
- Medicare Health Outcomes Survey: An Alternative Case-Mix Methodology (PDF,
121 KB). The Medicare HOS program uses the outcomes of change in health status after
adjustment with a fairly complex multi-modeling case-mix methodology. The purpose
of this study was to use a theory and evidence-based hierarchical approach to develop
and test an alternative case-mix methodology that is simpler and more parsimonious.
-
Veterans RAND 12 Item Health Survey (VR-12): A White Paper Summary (PDF,
21 KB). This report describes the Veterans RAND 12 Item Health Survey (VR-12; formerly
called the Veterans SF-12), a health questionnaire developed from the Veterans Health
Study spanning the physical to the psychological domains and used as the core outcome
measure in HOS 2.0. The summary includes: (1) background; (2) VR-12 contents, scoring
and imputation algorithms for handling missing data; (3) analysis of VR-12; and
(4) current and future plans for the VR-36 and VR-12.
- Estimation and Analysis of Non-Response Bias in Medicare Surveys
- Final Report (PDF, 446 KB) This report examines the potential
degree of non-response bias in two major survey efforts that collect information
from five different Medicare beneficiary populations: the 2000 Medicare Health Outcomes
Survey (HOS) and the 2000 Consumer Assessment of Health Plans Survey (CAHPS®).
The report explores the two possible types of non-response and the premise that
non-response may be a major threat to the validity of survey sample estimates.
-
HOS/CAHPS® Survey Integration Formative Study Design - Final Report (PDF,
728 KB)
This document provides a preliminary assessment to determine the feasibility of
integrating the HOS and the Medicare Advantage (MA) CAHPS® surveys
into one survey instrument. To conduct this assessment, HSAG gathered and reviewed
information from a variety of sources, including 1) key stakeholders; 2) published
and unpublished literature; and 3) analyses of data from the HOS, MA CAHPS®,
and Medicare Fee-For-Service CAHPS® surveys. This report summarizes
the findings. To evaluate the feasibility of integrating the HOS and MA CAHPS®
surveys, seven key aspects of these two surveys were examined: Questionnaire Content;
Survey Administrative Protocols; Analytic Strategies; Sampling Methods; Cost and
Burden; Dissemination of the Results; and Uses of the Results. This report will
help to inform future discussions regarding the advantages and disadvantages of
integration.
- Imputing Physical and Mental Summary Scores (PCS and MCS) for
the Veterans SF-12 Health Survey in the Context of Missing Data (PDF,
468 KB)
This report describes a new method (modified regression estimation) for estimating
the Physical Component Score (PCS) and the Mental Component Score (MCS) from the
Veterans 12-Item Health Survey in the context of missing data. The report provides
a SAS® macro implementing this method, with instructions for use of
the macro.
- Imputing the Physical and Mental Summary Scores (PCS and MCS)
for the MOS SF-36 and the Veterans SF-36 Health Survey in the presence of Missing
Data (PDF, 436 KB)
This report compares five different methods for imputing missing data in responses
to a 36-item health survey. The various methods are compared in terms of both variance
and degree of bias.
- Calculating HOS Performance Measurement Results (PDF,
291 KB)
This document provides a detailed outline of the steps utilized for the calculation
of Cohorts 1-6 HOS Performance Measurement results. The Performance Measurement
results are based on risk adjusted mortality rates, and changes in physical and
mental functioning and well being, among living beneficiaries over a two-year period.
SAS® code utilized for the calculation of the Cohort 3 Performance
Measurement results is also included.
- HOS/VA (Veterans
Administration) Comparison Project Part 1: Measurement Equivalence of Medicare HOS
SF-36 and VA Veterans SF-36 (PDF, 1.63 MB)
This paper provides evidence that scales from a 36-item health survey can be computed
and compared between the HOS and VA. Although differences exist between the two
instruments, the paper's establishment of partial metric equivalence suggests
that quantitative comparisons between the two samples are appropriate.
- HOS/VA Comparison
Project Part 2: Test of Reliability and Validity at the Scale Level for the Medicare
HOS SF-36 and VA Veterans SF-36 (PDF, 305 KB)
This paper provides evidence that the scales and component summaries from the Veterans
36-Item Health Survey are as reliable and valid as those generated utilizing the
Medicare HOS version. The results strongly suggest that the Veterans 36-Item Health
Survey is suitable for comparisons at the scale level with the Medicare HOS version.
-
Psychometric Analysis of the Spanish-Language Version of the Medicare Health
Outcomes Survey (PDF, 860 KB)
This paper presents tests of data quality, scaling assumptions and reliability for
the Spanish-language version of the Medicare HOS 1.0. Additionally, it reviews the
psychometric and clinical validity of the Spanish instrument, including the calculation
of summary measures and SF-36® descriptive statistics.
Results
Manuals
- Ware, John E., Gandek, Barbara, Sinclair, Samuel J. and Kosinski,
Mark A. Measuring and Improving Health Outcomes: An SF-36® Primer
for the Medicare Health Outcomes Survey. Waltham MA: Health Assessment
Lab and Quality Metric Incorporated, 2004.
This primer provides general information about the HOS: how it came to be, what
its components are, how HOS data are collected and analyzed, and how HOS results
have been used. Information on the construction, scoring, reliability, validity
and interpretation of the SF-36® Health Survey is summarized. Multiple
tables of normative data are included to allow health plans and others using the
SF-36® to compare their 1998-2005 HOS data with reference norms for
the Medicare managed care population, overall and by categories such as age and
gender. Examples of studies that demonstrate the impact of interventions such as
disease management and geriatric assessment in improving or maintaining SF-36®
scores are provided. Copies of the primer may be purchased via
QualityMetric's Secure Online Order Center (www.qualitymetric.com).
Peer Reviewed Articles
- Ng, Judy H., Judith D. Kasper, Christopher B. Forrest, and Arlene S. Bierman.
"Predictors of Voluntary Disenrollment from Medicare Managed Care." Medical Care.
June 2007. Volume 45 (6): 513-520.
- Harris, Yael. "Depression as a Risk Factor for Nursing Home Admission Among
Older Individuals." Journal of the American Medical Directors Association.
January 2007. Volume 8 (1): 14-20.
- Bierman, Arlene S.; Ellis, Beth Hartman; and Drachman, David. "Depressed
Mood and Mental Health Among Elderly Medicare Managed Care Enrollees." Health Care
Financing Review. Summer 2006. Volume 27(4): 123-136. Available online
at
CMS' Health Care Financing Review website.
- Mardon, Russell E., Halim, Shaheen, Pawlson, L. Gregory, Haffer,
Samuel C. "Management of Urinary Incontinence in Medicare Managed Care Beneficiaries:
Results from the 2004 Medicare Health Outcomes Survey." Archives of Internal Medicine.
May 2006. 166: 1128-1133.
- Selim, Alfredo J., Kazis, L. E.; Rogers, W.; Qian, S.; Rothendler, J. A.; Lee, A.;
Ren, X. S.; Haffer, S. C.; Mardon, R.; Miller, D.; Spiro, A.; Selim, B. J.; Fincke,
B. G. "Risk-Adjusted Mortality as an Indicator of Outcomes: Comparison of the Medicare
Advantage Program With the Veterans' Health Administration." Medical Care.
April 2006. Volume 44(4): 359-365.
- Harris, Yael and Cooper, J. K. "Depressive Symptoms in Older People Predict Nursing
Home Admission." Journal of the American Geriatrics Society. April 2006.
Volume 54(4): 593–597.
- Ko, Yu and Coons, Stephen Joel. "An Examination of Self-Reported Chronic Conditions
and Health Care Status in the 2001 Medicare Health Outcomes Survey." Current Medical
Research and Opinion. November 2005. Volume 21(11): 1801-1808.
- Moriarty DG, Kobau R, Zack MM, Zahran HS. "Tracking Healthy Days - A Window on the
Health of Older Adults." Preventing Chronic Disease. July 2005. Volume
2(3): 1–8.
- Grace, Susan C., Shannon, Erin Dowd, Drachman, David, and
Ellis, Beth Hartman. "Multiple Cohorts Analysis of the Medicare Health Outcomes
Survey, 1998-2002." Health Care Financing Review. Spring 2005. Volume
26(3): 125-128. Available online at
CMS' Health Care Financing Review website.
- Lied, Terry R. and Haffer, Samuel C. "Health Status of Dually Eligible Beneficiaries
in Managed Care Plans." Health Care Financing Review. Summer 2004.
Volume 25(4): 59-74. Available online at
CMS' Health Care Financing Review website.
- Ellis, Beth Hartman, Shannon, Erin Dowd, Cox, Jacquilyn Kay, Aiken, Leona and Fowler,
Brenda M. "Chronic Conditions: Results of the Medicare Health Outcomes Survey,
1998-2000." Health Care Financing Review. Summer 2004. Volume 25(4):
75-91. Available online at
CMS' Health Care Financing Review website.
- Bierman, Arlene S. "Coexisting Illness and Heart Disease Among Elderly Medicare
Managed Care Enrollees." Health Care Financing Review. Summer 2004.
Volume 25(4): 105-117. Available online at
CMS' Health Care Financing Review website.
- Kuo, Yong-F., Peek, M. Kristen, Raji, Mukaila A., and Goodwin, James S. "Health-Related
Social Disengagement in Elderly Diabetic Patients: Association with Subsequent Disability
and Survival." Diabetes Care. July 2004. Volume 27(7): 1630–1637.
- Ellis, Beth Hartman, Bannister, Wade M., Cox, Jacquilyn Kay, Fowler, Brenda M.,
Shannon, Erin Dowd, Drachman, David, Adams, Randall W. and Giordano, Laura A. "Utilization
of the propensity score method: an exploratory comparison of proxy-completed to
self-completed responses in the Medicare Health Outcomes Survey." Health and
Quality of Life Outcomes. September 18, 2003. Volume 1(47): Available online
at www.hqlo.com.
- Arday, David R., Milton, Micah H., Husten, Corinne G., Haffer, Samuel C., Wheeless,
Sara C., Jones, Shelton M. and Johnson, Ruby E. "Smoking and Functional Status
Among Medicare Managed Care Enrollees". American Journal of Preventive Medicine.
April 2003. Volume 24(3): 234-241.
- Haffer, Samuel C., Bowen, Sonya E., Shannon, Erin Dowd and Fowler, Brenda M. "Assessing
Beneficiary Health Outcomes and Disease Management Initiatives in Medicare."
Disease Management and Health Outcomes. February 2003. Volume 11(2): 111-124.
- Baker, Frank, Haffer, Samuel C. and Denniston, Maxine. "Health-Related Quality
of Life of Cancer and Noncancer Patients in Medicare Managed Care." Cancer.
February 1, 2003. Volume 97(3): 674-681.
- Lied, Terry R., Sheingold, Steven H., Landon, Bruce E., Shaul, James A., and Cleary,
Paul D. "Beneficiary-Reported Experience and Voluntary Disenrollment in Medicare
Managed Care." Health Care Financing Review. Fall 2003. Volume 25(1): 55–66. Available
online at
CMS' Health Care Financing Review website.
- Moriarty, David G., Zack, Mathew M., and Kobau, Rosemarie "The Centers for Disease
Control and Prevention's Healthy Days Measures – Population Tracking of Perceived
Physical and Mental Health Over Time." Health Quality Life Outcomes, 2003.
Volume 1: 37.
- Schwab, T. C., Leung, K.-M., Gelb, E., Meng, Y.-Y., and Cohn, J. "Home- and Community-Based
Alternatives to Nursing Homes: Services and Costs to Maintain Nursing Home Eligible
Individuals at Home." Journal of Aging and Health. 2003. Volume 15: 353–370.
- Fody-Urias, B. M., Fillit, H., Hill, J. "The Effect of a Fitness Program on Health
Status and Health Care Consumption in Medicare MCOs." Managed Care Interface.
September 2001. Volume 14(9): 58-64.
- Cooper, James K., Harris, Yael and McGready, John. "Sadness Predicts Death
in Older People." Journal of Aging and Health. November 2002. Volume
14(4): 509-526.
- McCall, Nancy T., Parks, Peggy, Smith, Kevin, and Griggs, Michelle. "The Prevalence
of Major Depression or Dysthymia Among Aged Medicare Fee-for-Service Beneficiaries."
International Journal of Geriatric Psychiatry. 2002. Volume 17: 557-565.
- Bierman, Arlene S., Lawrence, William F., Haffer, Samuel C. and Clancy, Carolyn
M. "Functional Health Outcomes as a Measure of Health Care Quality for Medicare
Beneficiaries." Health Services Research. December 2001. Volume 35(6)
Part II: 90-109.
- Cooper, James K. and Kohlmann, Thomas. "Factors Associated with Health Status
of Older Americans." Age and Ageing. November 2001. Volume 30(6):
495-501.
- Bierman, Arlene S., Haffer, Samuel C. and Hwang, Yi-Ting. "Health Disparities
Among Older Women Enrolled in Medicare Managed Care." Health Care Financing
Review. Summer 2001. Volume 22(4): 187-198.
- Bierman, Arlene S., Haffer, Samuel C., Hwang, Yi-Ting and Mandelblatt, Jeanne. "Elderly
Women in Managed Care: Impact of Race/Ethnicity, Education, and Income on HRQOL."
Quality of Life Research. October 2000. Volume 9(3). Published Abstract.
- Haffer, Samuel C., Bierman, Arlene S., Hwang, Yi-Ting and Mandelblatt, Jeanne. "Assessing
the HRQOL of Socioeconomically Disadvantaged Elders in Medicare Managed Care." Quality
of Life Research. October 2000. Volume 9(3). Published Abstract.
- Arday, David R. "Receipt of Advice to Quit Smoking in Medicare Managed Care
- United States, 1998." Morbidity and Mortality Weekly Report (MMWR).
September 8, 2000. Volume 49(35): 797-801.
- Stevic, Marcia O., Haffer, Samuel C., Cooper, James, Adams, Randall and Michael,
James. "How Healthy ARE our Seniors?: Baseline Results from the Medicare Health
Outcomes Survey." Journal of Clinical Outcomes Management. August
2000. Volume 7(8): 39-42.
Technical Reports
- Implementing the HEDIS® Medicare Health Outcomes
Survey: Final Protocol Analysis Cohorts 5-9 (2002-2006) (PDF, 141
KB) This Protocol Analysis report is based on data analysis from the 2002-2006 (Cohorts
5-9) Medicare Health Outcomes Survey (HOS) administrations. The purpose of this
report is to describe changes in the composition of the cohorts over the years and
to examine the quality and completeness of the survey data. The 2006 administration
of the HOS marked its ninth year of baseline administration and seventh year of
follow-up administration in Medicare Advantage (MA) plans. It is also the first
year that the revised HOS questionnaire, referred to as HOS 2.0, replaced the previous
questionnaire version. NCQA performed a series of analyses of the available HOS
data to uncover trends in HOS administration in recent years.
- Implementing the HEDIS® Medicare Health Outcomes
Survey: The Impact of Health Plan Quality on Medicare Beneficiary Outcomes (PDF,
347 KB). This report assesses the relationship of plan-level performance on HEDIS®
measures of clinical processes and intermediate outcomes with changes over two-years
in the self-reported physical and mental health outcomes from the Medicare HOS among
elderly Medicare plan enrollees with diabetes, hypertension, ischemic heart disease,
and depression. This study represents one of the first attempts to directly link
plan HEDIS® performance to outcome measures of enrollee health.
- Implementing the HEDIS® Medicare Health Outcomes
Survey: Final Protocol Analysis Cohorts 4 through 9 2001 through 2006 (PDF,
126 KB)
This report describes changes in the composition of the cohorts over the years and
examines the quality and completeness of the survey data. A series of analyses were
performed to look at trends in the HOS administration including: (1) attrition from
baseline to follow up; (2) response rates and sample dispositions in baseline and
follow up samples; (3) mode differences in recent baseline samples; and (4) response
rates and sample dispositions of preliminary Cohort 9 Baseline data.
- Multiple Cohorts Analysis:
Longitudinal Analysis of SF-36® Summary Scores in the Medicare Health
Outcomes Survey - Final Report (PDF, 250 KB) This technical
report examines changes in the PCS and MCS scores for beneficiaries of Medicare
Advantage (MA) Plans (formerly referred to as Medicare + Choice Organizations) who
completed a Medicare Health Outcomes Survey at yearly intervals from 1998 through
2002. This study incorporates data from those MA beneficiaries that participated
in the HOS on more than one occasion. Trends in physical component summary and mental
component summary scores were examined for beneficiaries who completed the survey
two years, three years, four years, and five years in a row. The examination of
these trends provides information on whether or not declines in health status accelerate
over time or remain constant. This information is valuable in determining the optimal
number of years to wait before conducting the follow up survey.
- Evaluation of Disease Status based on Patient Self-Report in
the Medicare Health Outcomes Survey
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