Publications and Resources
Applications/Interventions
The Medicare HOS Program Partners and other leading health outcomes experts are involved in research using 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 the Journal of Ambulatory Care Management, Journal of Clinical Epidemiology, Medical Care, 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 quality of care, functional health, health utilities, obesity, depression, smoking, health disparities, and chronic illness have been investigated using HOS data. For additional information on Medicare HOS research, please contact the HOS Information and Technical Support Line.
The lists of publications in the following links below (fact sheets, peer-reviewed articles, and technical reports) have been assembled to provide additional information on the Medicare HOS and to facilitate the use of the HOS data files produced by the Medicare HOS Program.
Office of Minority Health (OMH) Reports
- OMH Report: Understanding the Health Needs of Hispanic Medicare Beneficiaries (PDF, 951KB) 2018
This report presents findings from the Medicare HOS using pooled data from three fielded baseline surveys: Cohorts 16, 17, and 18 (2013-2015). Health status results presented in this report include self-rated general health status, number of days with activity limitations, rate of depression, prevalence of obesity, two measures of recent pain, and two new measures of sleep health. The findings indicate that at least half of all Hispanic beneficiaries report fair or poor health and the rate of positive depression screen is significantly different across Hispanic groups. Associated report data tables are made available at the Research Reports portal of the CMS OMH website. A Data Highlight is also available and summarizes the information provided in the full report. - OMH Data Highlight: Understanding the Health Needs of Diverse Groups of Hispanic Medicare Beneficiaries (PDF, 220KB) 2018
The Data Highlight summarizes the self-reported health needs of detailed groups of Hispanic Medicare Advantage (MA) beneficiaries. The highlight characterizes the distribution of chronic diseases, general health status, sleep measures, and prevalence of obesity among different Hispanic sub-groups: Cuban, Mexican, Puerto Rican, multi-ethnic Hispanics and other Hispanics. The full report and the associated report tables may be obtained from the Research Reports portal of the OMH website. - OMH Data Highlight: Racial and Ethnic Disparities in Mental Health Among Diverse Groups of MA Beneficiaries (PDF, 348 KB) 2017
This Data Highlight presents findings from the Medicare HOS using pooled data from the three most recently fielded baseline surveys: Cohorts 17, 18, and 19 (2014-2016). The data highlight describes the racial and ethnic disparities in mental health among diverse groups of MA beneficiaries. The report identifies that relative to other races, American Indian and Alaska Native as well as Native Hawaiian or Other Pacific Islander (NHOPI) beneficiaries generally reported worse mental health status across multiple indicators related to depression and depression symptoms, days of activities missed because of poor physical and mental health, and mental health functioning. - OMH Data Highlight: Understanding the Health Needs of Diverse Groups of Asian and NHOPI Medicare Beneficiaries (PDF, 610 KB) 2017
This Data Highlight provides an enhanced understanding of the health needs of diverse groups of Asian and NHOPI MA beneficiaries. Since 2013, the Medicare HOS has been reporting disaggregated results for distinct Asian and NHOPI groups. The Asian category includes beneficiaries who self-identified as Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, or Other Asian. The NHOPI category includes beneficiaries who self-identified as Native Hawaiian, Guamanian or Chamorro, Samoan, or Other Pacific Islander. The highlight summarizes the information provided in the full report. - OMH Report: Understanding the Health Needs of Diverse Groups of Asian and NHOPI Medicare Beneficiaries (PDF, 905 KB) 2017
The Report features the self-reported health needs of disaggregated groups of Asian and NHOPI MA beneficiaries. The report characterizes the distribution of chronic diseases, general health status, sleep measures, and prevalence of obesity among the diverse beneficiaries. The full report and the corresponding data tables in an Excel format can be downloaded from the Research Reports portal of the CMS OMH website. - OMH HOS Fact Sheet (PDF, 171 KB) 2015
This fact sheet highlights the race and ethnicity of respondents to the most recent HOS administrations. Since April 2013, the Medicare HOS has collected measures of race, ethnicity, sex, primary language, and disability status in accordance with the standards established by section 4302 of the Affordable Care Act. These newly expanded demographic measures, combined with the self-reported health status measures captured by the HOS, provide a rich source of data that may be useful for research. - OMH HOS Data Brief on Asian Americans and Pacific Islanders (PDF, 208 KB) 2015
This data brief highlights the Medicare HOS as a unique source of information about Asians and NHOPI and shows the distribution of chronic diseases, ADLs, and HEDIS rates among Asian Americans and Pacific Islanders. On October 14, 2009, the White House Initiative on Asian Americans and Pacific Islanders was re-established. The Initiative works to improve the quality of life and opportunities for Asian Americans and Pacific Islanders by facilitating increased access to and participation in federal programs where they remain underserved.
Journal Articles
This list also includes selected reference publications about the National Cancer Institute’s (NCI) Surveillance, Epidemiology, and End Results (SEER) and the Medicare Health Outcomes Survey (MHOS) linked data sets available to cancer researchers. More information about this linkage and a more complete listing is found on the NCI SEER-MHOS page.
- Adapting the Vulnerable Elders Survey-13 to Predict Mortality Using Responses to the Medicare Health Outcomes Survey. 2017
Beckett MK, Elliott MN, Ritenour D, et al.
Journal of American Geriatrics Society. 2017; 65(5):1051-1055. Abstract available online at https://www.ncbi.nlm.nih.gov/pubmed/28369691. - Differences in Receipt of Three Preventive Health Care Services by Race/Ethnicity in Medicare Advantage Plans: Tracking the Impact of Pay for Performance, 2010 and 2013. 2016
Jung DH, Palta M, Smith M, et al.
Preventing Chronic Disease. 2016; 13:160047. Article available online at http://dx.doi.org/10.5888/pcd13.160047. - Revisiting the Surveillance Epidemiology and End Results Cancer Registry and Medicare Health Outcomes Survey (SEER-MHOS) Linked Data Resource for Patient-Reported Outcomes Research in Older Adults with Cancer. 2016
Kent EE, Malinoff R, Rozjabek HM, et al.
Journal of the American Geriatrics Society. 2016; 64(1):186-92. Abstract available online at http://dx.doi.org/10.1111/jgs.13888. - Associations Between Health-Related Quality of Life and Mortality in Older Adults. 2015
Brown DS, Thompson WW, Zack MM, et al.
Prevention Science. 2015; 16(1):21-30. Abstract available online at http://dx.doi.org/10.1007/s11121-013-0437-z. - The Impact of Pain on Physical and Mental Quality of Life in Adults 65 and Older. 2013
Hawkins K, Musich S, Bottone FG, et al.
Journal of Gerontological Nursing. 2013;39(6):32-44. Abstract available on line at U.S. National Library of Medicine website. - The Relationship between Body Mass Index and Quality of Life in Community-Living Older Adults Living in the United States. 2013
Bottone FG, Hawkins K, Musich S, et al.
Journal of Nutrition, Health & Aging. 2013;17(6):495-501. Abstract available on line at U.S. National Library of Medicine website. - The Burden of Falling on the Quality of Life among Adults with Medicare Supplement Insurance. 2011
Hawkins K, Musich S, Ozminkowski RJ, et al.
Journal of Gerontological Nursing. 2011 Aug;37(8):36-47. Epub 2011 Apr 13. Abstract available online at U. S. National Library of Medicine website and the article may be accessed directly from the SLACK Journals website. - SEER-MHOS: A New Federal Collaboration on Cancer Outcomes Research. 2008
Clauser SB, Haffer SC.
Health Care Financing Review. Summer 2008. Volume 29(4): 1-4. Available online at CMS’ Health Care Financing Review website. - Overview of the SEER-Medicare Health Outcomes Survey Linked Dataset. 2008
Ambs A, Warren JL, Bellizzi KM, et al.
Health Care Financing Review. Summer 2008. Volume 29(4): 5-22. Available online at CMS’ Health Care Financing Review website. - Functional Impairment Levels in PACE Enrollees. 2008
Walsh EG, Khatustsky G, Johnson L.
Health Care Financing Review. Summer 2008. Volume 29(4): 81-88. Available online at CMS’ Health Care Financing Review website. - The Health of Seniors Project. 1998
Haffer SC, Cooper JK, Gordon C.
Managed Care and Aging. American Society on Aging. Summer, 1998. Volume 5(2).
Technical Reports
- Analysis of Key Drivers of Improving or Maintaining Medicare Health Outcomes Survey (HOS) Scores. 2013
This study used data from the HOS 2009 Cohort 12 Baseline and 2011 Cohort 12 Follow Up to describe how two-year mortality and two-year changes in the Veterans RAND 12-Item Health Survey (VR-12) items relate to key Medicare HOS measures used in the Medicare Star Ratings. The HOS measures relate to maintaining and improving health and are derived from changes in the physical component summary (PCS) and mental component summary (MCS) scores. The results from this study clarify the properties of several Centers for Medicare & Medicaid Services’ (CMS) quality measures used for the Medicare Star Ratings. - Identifying Elderly HOS Beneficiaries at Risk for Mortality Using the Updated 2009 VES-HOS Risk Scoring. 2013
The focus of this research was to extend and improve a previously validated Vulnerable Elders Survey-Medicare Health Outcomes Survey (VES-HOS) predictive model for identifying older adults at high risk of mortality using the HOS 2.0. In particular, an assessment was made of whether the approach is robust to the substitution of survey items. The previously validated VES-HOS model (and the approach it is based on, the original VES-13 instrument) was extended by incorporating an imputation approach that allows for the retention of a substantial proportion of the sample previously excluded because they were missing one or more items used by the algorithm. In addition, the algorithm’s performance by gender was verified; three, rather than two, risk groups were distinguished based on the risk score; and the members of vulnerable groups were characterized. - Opportunities for Improving Medicare HOS Results through Practices in Quality Preventive Health Care for the Elderly (PDF, 1.0 MB) 2012
This guide is a resource to help Medicare Advantage Organizations (MAOs) develop and apply strategies that address the Medicare Health Outcomes Survey (HOS) items used in the CMS Medicare Part C Star Ratings. The guide includes an overview of HOS, national performance results on HOS items included in the Medicare Star Ratings, best practices in promoting quality preventive health care for the elderly, and HOS resources available to MAOs. Section 1 discusses the prevalence of conditions measured by the HOS items and provides a summary of national HOS results to highlight opportunities for improvement and intervention strategies. Section 2 provides examples of interventions that some MAOs have used to promote patient-physician communication, screening services or maintenance of functional status among their members. - Functional Status in Older Adults: Intervention Strategies for Impacting Patient Outcomes (PDF, 1.2 MB) 2011
This literature review is a synthesis of selected articles of functional status outcomes in older adults and is designed to supplement the guide for MAOs entitled, “Opportunities for Improving Medicare HOS Results through Practices in Quality Preventive Health Care for the Elderly.” The included outcomes target short form assessments of health that span the physical to psychological from well established questionnaires. In addition, outcome measures include activities of daily living that capture functional limitations in Medicare Advantage recipients. The articles were selected from the vantage point of interventions that could impact on the functional status outcomes in elderly populations. The HOS includes the Veterans RAND 12 Item Health Survey (VR-12) as the core measure for the physical (PCS) and mental (MCS) summary scores. It also includes HEDIS® Effectiveness of Care Measures for Management of Urinary Incontinence in Older Adults, Physical Activity in Older Adults, Fall Risk Management and Osteoporosis Testing in Older Women. - Medicare Part D Data Linked with the Health Outcomes Survey: Association between Quality of Care using Prescription Drugs and Mortality as Outcomes among those Enrolled in the Medicare Advantage Program (PDF, 715 KB) 2010
This report examines the relationship between use of medications based upon nationally recognized clinical practice guidelines and health outcomes using mortality among Medicare Advantage (MA) patients enrolled in the Medicare Part D program. The analysis utilized the linked data from the Medicare Health Outcomes Survey (HOS) 2006-2008 Cohort 9 and the 2006-2007 Medicare Part D prescription benefit files to calculate the medication based performance indicators for five high volume chronic conditions: diabetes, coronary artery disease (CAD), congestive heart failure (CHF), chronic obstructive lung disease (COPD)/asthma, and depression. The investigators examined the variations of the performance indicators across plans and examined the associations of performance indicators and mortality at the patient and the plan levels. - Implementing the HEDIS® Medicare Health Outcomes Survey: Linking Medicare Health Outcomes Survey Data and Part D Drug Data (PDF, 296 KB) 2010
This report discusses the linking of the Medicare Health Outcomes Survey (HOS) 2006-2008 Cohort 9 and the 2006–2007 Medicare Part D Drug Event (PDE) data, which allowed examination of associations between drug benefits and use, as well as patient-specific health and functional status. Two separate analyses were conducted. The initial analysis focused on assembling the linked HOS and Part D data master file and evaluating key demographic differences between HOS respondents who had a Part D benefit claim and those who did not. The second part of the analysis examined Part D prescription drug use among MA members in the HOS sample. - Implementing the HEDIS® Medicare Health Outcomes Survey: Applying Missing Data Imputation Methods to HOS Household Income Data (PDF, 359 KB) 2009
The 2006 HOS Cohort 9 Baseline data was used to investigate several missing data imputation methods for self-reported income, which consistently experiences a high rate of missing data in the HOS. This report provides a brief summary of selected statistical methods that use existing information from the HOS data set, applies them to the data for missing income values, and compares results across the various methods. This work is an extension of previous NCQA research that used an external data source for the imputation. - Implementing the HEDIS® Medicare Health Outcomes Survey: Imputation Analysis for HOS Income Data (PDF, 155 KB) 2008
Data from the Medicare Health Outcomes Survey (HOS) offer important longitudinal information about insights into the self-assessed health status of the older population in the United States. CMS has surveyed this population annually over several years and repeatedly found that income information is missing in Baseline and Follow-up surveys for about 10-20 percent of respondents. To address this issue and to generate complete information across HOS data sets, CMS is collaborating with NCQA to explore and help define a valid income imputation method using HOS 2000 Cohort 3 Baseline and HOS 2006 Cohort 9 Baseline data that could be applied to other HOS cohorts. - Report on the Health Status of Managed Care Smokers and Nonsmokers: Cohort III Baseline and Follow Up (PDF, 313 KB) 2007
This research examines differences in physical and mental health status for beneficiaries who were smokers and nonsmokers in Cohort III (2001-2003) of the Medicare Health Outcomes Survey (HOS). - Disparities in Medicare Beneficiary Outcomes: Socio-Demographic Vulnerability and Prevalent Problems in Older Populations (PDF, 242 KB) 2007
Ng JH, Scholle SH, Wong L, et al. This report assesses the extent to which receipt of recommended preventive services varies by vulnerability status. Studies indicate that vulnerable Medicare Managed Care subgroups, such as racial/ethnic minorities or low socioeconomic populations, continue to disproportionately experience quality of care problems. Strategies to reduce disparities have generally emphasized the importance of improving preventive services. - Report on a Longitudinal Assessment of Change in Health Status and the Prediction of Health Utilization, Health Expenditures, and Experiences with Care for Beneficiaries in Medicare Managed Care (PDF, 298 KB) 2006
This report explores longitudinal change in beneficiary physical and mental health, bodily pain, and impaired Activities of Daily Living (ADLs) in 2002, and relates these health measures to health care usage and expenditures in 2003. Additionally, the report examines whether changes in health status from 2000-2002 relate to patient experience with care ratings in 2002. In sum, longitudinal changes in health status were found to significantly relate to future health care costs and utilizations. - The Evaluation of a Mental Component Summary Score Threshold for Depression Risk in the Medicare Population (PDF, 367 KB) 2006
This report examines different thresholds of mental component summary (MCS) scores for identifying beneficiaries diagnosed with depression, and those at risk for depression. The results indicated a low prevalence of depression (7%) based on the diagnoses recorded on claims data among Medicare FFS beneficiaries. Beneficiaries with depression diagnoses had lower MCS scores than those without depression diagnoses. The results indicated that a score of 48 represents reasonable predictive accuracy and would imply screening for 20% of elderly beneficiaries. - The Relationship between Health Status, Utilization, and Expenditures: Comparison between Medicare Managed Care and Fee-For-Service Beneficiaries (PDF, 554 KB) 2006
This report examines possible differences in the relationship between health status, health expenditures, utilization of services, and experiences with care between Medicare FFS and managed care (Medicare Advantage [MA]) beneficiaries. As expected, higher expenditures are associated with lower PCS and MCS scores, with small but statistically significant differences between managed care and FFS. Significant differences were found between the self-reported frequency of FFS and managed care beneficiaries' visits to doctors' offices or clinics at lower levels of physical and mental health. Finally, managed care beneficiaries have a significantly higher probability of providing low satisfaction ratings when compared to FFS beneficiaries. - National and State Comparisons of Health Status for Medicare Managed Care and Fee-For-Service Beneficiaries (PDF, 406 KB) 2006
Analysis was conducted to compare the longitudinal change of physical and mental health status of the 2002-2004 Medicare HOS to a simulated longitudinal change in the 2002 and 2004 CAHPS Fee-For-Service. At a national level, the results indicated that there is not a significant difference between Medicare Fee-For-Service and Managed Care beneficiaries in relation to the amount of physical and mental health status change for the years examined. - Report on the Health Status of Disadvantaged Medicare Beneficiaries (PDF, 690 KB) 2005
This report examines the predictors of disparities in health outcomes for Medicare beneficiaries in Cohorts 2 and 3 of the Medicare Health Outcomes Survey (HOS). - Report on Enrollment Duration: Cohort I Baseline (PDF, 135 KB) 2005
This paper presents potential differences in health status between Medicare Health Outcomes Survey (HOS) Cohort I Baseline (1998) beneficiaries with fewer than six months tenure in their health plans and those with more than six months tenure. - Report on Mental Health Status of Managed Care Beneficiaries: Cohort I Baseline and Follow Up (PDF, 339 KB) 2005
This research examines the differences between beneficiaries at high risk for depression and those at low risk for depression sampled in the Medicare Health Outcomes Survey (HOS). - Using Claims Data to Identify Medicare+Choice Enrollees At Risk for a Decline in Functional Health Status (PDF, 200 KB) 2005
Welch WP. This report presents results from a study sponsored by the Agency for Healthcare Research and Quality to identify Medicare managed care enrollees at risk for a decline in health status. Using HOS data and Medicare managed care administrative data, the analysis characterized utilization of health care and developed risk models for identifying enrollees appropriate for early medical intervention. - Report on the Comparison of Seniors in Program of All-Inclusive Care for the Elderly (PACE) and Medicare Advantage Plans: Cohorts II, III, IV and V Baseline (PDF, 278 KB) 2005
This report compares the health status of beneficiaries enrolled in Program of All-Inclusive Care for the Elderly (PACE) plans with the health status of beneficiaries enrolled in Medicare managed care plans who participated in Cohorts II, III, IV and V Baseline (1999 to 2002) of the Medicare Health Outcomes Survey (HOS). - Medicare HOS National Pilot Project on Depression Final Report (PDF, 438 KB) 2002
From 1999 to 2002, 16 M+COs and six QIOs participated in a pilot project to develop a strategy for using the HOS results to identify and treat beneficiaries with a high risk for depression. Claims and HOS data were used to develop a statistical profile of these high-risk beneficiaries. Each M+CO then provided their primary care providers with a list of the high-risk beneficiaries in their caseloads, as well as screening instruments, clinical guidelines, and treatment protocols for depression management. The participating plans were compared to non-participating plans to measure the impact on both process measures and HOS scores. A copy of the Pilot Project User's Guide is also available. - Evaluating the Two-Year Follow Up Health Status of Medicare Fee-For-Service Beneficiaries Using the Health Outcomes Survey (PDF, 2.7 MB) 2002
Trisolini MG, McCall NT, Pope GC, et al. This report presents an analysis of follow up results for the HOS, which was administered to a sample of Medicare Fee-for-Service beneficiaries in 1998 and 2000. The primary goal of this analysis is to assess the feasibility of using longitudinal estimates of self-reported health status for cohorts of Medicare beneficiaries to evaluate the care provided to Fee-for-Service beneficiaries by physician group practices or by Fee-for-Service providers in small geographic areas. - Medicare HOS National Pilot Project on Depression User's Guide (PDF, 444 KB) 2002
This project represents a pioneering attempt to use HOS data to help identify and manage depression in a primary care setting. Six QIOs and 16 health plans participated in this quality improvement pilot project. - The SF-36® Health Survey: A Summary of Responsiveness to Clinical Interventions (PDF, 103 KB) 2000
This paper provides evidence that the SF-36® scales and summary measures are sensitive measures that can demonstrate changes in health due to various treatments, including pharmacological, surgical, and educational interventions. - Medicare HOS Information Synthesis (PDF, 3.4 MB) 1999
This 1999 document reviews a number of interventions that have an effect on the overall well-being and functional status of seniors. The intent of the review is to provide direction in developing new interventions that are relevant to the specific needs of Medicare beneficiaries.
| Note: Some of the files on this page are available only in Adobe Acrobat - Portable Document Format (PDF). To view PDF files, you must have the latest version of Adobe Acrobat Reader. If you do not already have the Acrobat Reader installed, please go to Adobe's Acrobat download page now. |
This page was last modified on 02/15/2024
| Privacy | Contact Us | FAQs | Glossary | Program Partners |
