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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 or available for direct download from the CMS HOS Website download directory (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

• Sample Baseline Report (PDF, 2.1 MB)
  After the administration of each baseline cohort, a cohort specific baseline report is produced. The baseline reports present SF-36® Physical Component Summary (PCS) and Mental Component Summary (MCS) 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 health status indicators and demographics (including a comparison between respondents and non-respondents).

• Sample Performance Measurement Report (PDF, 2.0 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.

Manuals

• National Committee for Quality Assurance (NCQA). HEDIS®, Volume 6: Specifications for the Medicare Health Outcomes Survey. Washington DC: NCQA Publication, 1998 - 2004.

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

• 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

• Calculating HOS Performance Measurement Results (PDF, 291 KB)
  This document provides a detailed outline of the steps utilized for the calculation of 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 III 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 SF-36® scales 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. An electronic version of the VA Veterans SF-36 is available for download: VA Veterans SF-36 Instrument (PDF, 360 KB).

• 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 VA Veterans SF-36 scales and component summaries are as reliable and valid as those generated utilizing the Medicare HOS version. The results strongly suggest that the VA Veterans SF-36 is suitable for comparisons at the scale level with the Medicare HOS version. An electronic version of the VA Veterans SF-36 is available for download: VA Veterans SF-36 Instrument (PDF, 360 KB).

• 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. Additionally, it reviews the psychometric and clinical validity of the Spanish instrument, including the calculation of summary measures and SF-36® descriptive statistics.

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 are being used. Information on the construction, scoring, reliability, validity and interpretation of the SF-36® Health Survey, which is the core HOS outcomes measure, is summarized. Multiple tables of normative data are included to allow health plans and others using the SF-36® to compare their 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

• 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.

• 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.

• 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

• MCS Outlier Evaluation Report (PDF, 1.44 MB)
  This project was a collaborative effort among CMS, HSAG, and NCQA. The evaluation involved surveying all 28 outlier plans from the Cohort I Performance Measurement Results, as well as 20 randomly selected "average" plans.

• Report on the Health Status of the Medicare Disabled (PDF, 209 KB)
  For Cohort I Baseline, 279,135 Medicare beneficiaries were sampled. 167,248 seniors (age 65 or older) responded to the survey. Additionally, 10,513 (out of a total of 18,864) disabled beneficiaries responded to the survey. This report performs a comparison between these two groups.

• Report on the Health Status of the Medicare Dual Eligible (PDF, 238 KB)
  For Cohort I Baseline, 171,510 Medicare beneficiaries responded to the survey. Additionally, 6,247 beneficiaries enrolled in both Medicare and Medicaid completed a survey. This report performs a comparison between these two groups.

Peer Reviewed Articles

• McDonald, Kathie, Ma, Jifeng and Dulabone, Elaine. "Use of HOS Data in Florida." Health Care Financing Review. Summer 2004. Volume 25(4): 93-104. Available online at CMS' Health Care Financing Review website.

• Selim, Alfredo J., Berlowitz, Dan R., Fincke, Graeme, Cong, Zhongxiao, Rogers, William, Haffer, Samuel C., Ren, Xinhua S., Lee, Austin, Qian, Shirley X., Miller, Donald R., Spiro, Avron, Selim, Bernardo J. and Kazis, Lewis E. "The Health Status of Elderly Veteran Enrollees in the Veterans Health Administration." Journal of the American Geriatrics Society. August 2004. Volume 52(8): 1271-1276.

• Bierman, Arlene S. and Clancy, Carolyn M. "Health Disparities Among Older Women: Identifying Opportunities to Improve Quality of Care and Functional Health Outcomes." Journal of the American Medical Women's Association. Fall 2001. Volume 56(4): 155-160.

Technical Reports

• Medicare HOS National Pilot Project on Depression Final Report (PDF, 438 KB)
  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 available below.

• The SF-36® Health Survey: A Summary of Responsiveness to Clinical Interventions (PDF, 329 KB)
  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 National Pilot Project on Depression User's Guide (PDF, 444 KB)
  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.

• Medicare HOS Information Synthesis (PDF, 3.4 MB)
  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.