The 2007 NHHCS had a stratified, two-stage probability
design. In the first stage, agencies were stratified by type (home
health, hospice, or mixed) and geographic location, and randomly
selected within strata. In the second stage, up to ten current
home health patients or hospice discharges, or a combination of
the two in mixed-type agencies were randomly selected within
each agency. The NHHCS patient health module had an overall
unweighted response rate of 66% (weighted: 55%).
Data were collected through in-person interviews with
designated home health staffs familiar with the selected
patients who examined patient medical records, administrative
records, and medication administration records to
answer questions. No patients, families, or friends were
interviewed. For each current home health patient, the
interviewer collected the names (brand or generic) of up to
25 medications the patient was currently taking, including
all standing, routine, or as-needed medications. This
information is typically based on an on-going account of
medications taken by the patient and maintained as part of
the home health medical records. All medications were
coded in terms of their generic component(s) and therapeutic
classifications using Lexicon Plus® by Cerner Multum,
Inc.11 Information on drug dosage, strength, route, and
frequency of administration was not available.
For the purpose of this analysis, we define current home
health patients at risk for PIM use as patients who were
65 years or older at the time of the interview and who had at
least one medication reported by the informant and recorded
by the NHHCS interviewer (n=3,124). Of all current elderly
home health patients, 3.1% had no current medications and
were excluded from our analysis.