Academic journal article Health Care Financing Review

Identification and Evaluation of Existing Nursing Homes Quality Indicators

Academic journal article Health Care Financing Review

Identification and Evaluation of Existing Nursing Homes Quality Indicators

Article excerpt

INTRODUCTION

Facility-specific reports on quality of care can be essential new tools to enhance quality and public accountability of health care services. Such reports can be used to benchmark facility performance with peer facilities within a State or nationally. Intermediate purchasers of care such as Medicare, Medicaid, or managed care organizations might use such external quality reports to avoid contracting with poor providers.

Public reporting of facility performance, an important new development, is now being piloted. The intent is to spur providers to compete on the basis of quality and to assist patients and their advocates in making informed decisions. Consumers, however, may not have expertise in interpreting QIs, and will not have the same level of access as surveyors to verify or refute impressions of facility performance gained from public reporting. What to report and how to present the information is, therefore, a matter of ongoing debate among experts. But no matter which decisions are taken to present the data, the development of QIs in multiple domains of quality is essential in meeting future public reporting goals.

To be useful for future public reporting and current regulatory and quality monitoring functions, QIs must meet certain measurement criteria including content validity, consistency over time periods, and validity in terms of representing quality within certain domains of care. Table 1 presents the list of desired measurement properties of QIs. The list may be used as a guideline for appraising and critically reviewing existing QIs. However, QIs may be useful for internal quality monitoring without demonstrating all the measurement properties listed in Table 1.

The audience for internal quality reports is intimately familiar with the facility, its patients, and care patterns. There is little risk of misinterpretation attached to quality reports as internal documents because readers will have ready access to the facility staff and patients to verify impressions left by the report. In that sense, the QI is a key starting point in the process of identifying and responding to opportunities to improve care.

QIs are used by facility surveyors in order to evaluate the processes and outcomes of care provided by a particular organization. In this case, the audience for the report is external. However, specially trained individuals external to the service organization typically conduct site visits during which they have the opportunity to interview staff, administrators, patients, and/or family members to gather additional information on the organization's care patterns and performance.

Before reviewing existing QIs, we propose a series of ratings on the degree to which various measurement properties are relevant for specific audiences: internal nursing facility staff, surveyors or external regulators, and for consumers. Table 2 presents the ratings for each type of audience. The ratings are consistent with the demands for more stringent measurement properties when QIs are used for public reporting than for surveyors or for internal quality monitoring.

This article addresses the early phases of work under a contract with CMS to develop and validate QIs for post-acute and LTC settings. The project was designed to assist CMS in advancing their vision for stimulating quality of care in nursing facilities by developing and validating QIs that reflect clinical and other care outcomes at the facility level. Prior to developing new QIs, the first task of this project was to assess existing QIs and to determine which of them, if any, could be recommended to CMS for immediate use. While previous work has focused primarily on how QIs could augment the regulatory process, the goal of this project was to identify QIs for multiple audiences, ranging from nursing facilities themselves to the consumers and purchasers of care.

Measuring Quality in U. …

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