The Power of Information: Using Resident Assessment Data to Assure and Improve the Quality of Nursing Home Care

By Zimmerman, David R. | Generations, Winter 1998 | Go to article overview

The Power of Information: Using Resident Assessment Data to Assure and Improve the Quality of Nursing Home Care


Zimmerman, David R., Generations


The potential to revolutionize the way in which quality care is assessed, assured and improved and to fundamentally alter the role of government in this process

In i986 the Institute of Medicine published its epic study of the status of nursing home care in the United States, painting a grim picture that identified several major deficiencies in the provision of care and making a number of far-reaching recommendations to address that situation. As a direct result, the regulation of nursing home care underwent a series of changes, largely through the Nursing Home Reform Act (OBRA) of I987.

Of these sweeping reforms, perhaps none was more singularly important than the requirement that all facilities perform a standardized evaluation of residents using the Resident Assessment Instrument, or RAI, based on a standardized assessment tool, the Minimum Data Set, or MDS (Morris et al., I990). This tool and the availability of standardized data from it have the potential to revolutionize the way in which the quality of nursing home care is assessed, assured, and improved and can fundamentally alter the role of government in this process.

THE GOVERNMENT'S ROLE

The government, at both the federal and state levels, has had a longstanding role in the assurance of quality of care in nursing homes. The legitimacy of that role is virtually indisputable. As the largest payer for long-term care, the government has a compelling reason-indeed, an entrusted responsibility-to assess and assure the adequacy of nursing home care provided to its beneficiaries. This responsibility is underscored by the fact that nursing home residents, by virtue of their level of impairment, which qualifies them for such care, are one of the most vulnerable populations in our society.

The nature of the government's role, however, has been the subject of considerable debate, in particular about the relative emphasis that should be placed on the government's enforcement versus consumer education and information functions. While few would argue with the position that the government needs to have a prominent and integral role in the enforcement of regulations in order to meet its protective responsibilities, there are questions about how effectively that role is being carried out and how it can be accomplished more effectively and efficiently. Somewhat lost in the enforcement debate, unfortunately, is the potential role of the government in facilitating provision of education and information about nursing home care. Throughout its history, the Health Care Financing Administration has been an important source of education for long-term-care providers and information for both providers and consumers, but there is much more that could be done. Especially with new technologies for distributing information and facilitating interactive communication, the government can become the catalyst for the enhanced training, education, and information dissemination efforts that have long been needed in the long-term-care field.

At the heart of this enhanced potential is the resident assessment information available in the MDS. It also has the potential to greatly increase both the effectiveness and the efficiency of the government's critical regulatory activities, and indeed provides the opportunity for all who are involved in the long-term-care endeavor to enhance the effectiveness of their quality improvement efforts. This article describes a set of quality indicators developed from information in the MDS. These are currently being used for both external quality assurance activities and for internal continuous quality improvement by facilities.

THE MDS QUALITY INDICATORS

Researchers at the Center for Health Systems Research and Analysis at the University of Wisconsin-Madison have developed a set of quality indicators that signal the presence or absence of potentially poor care practices or outcomes (Zimmerman et al. …

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