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BACKGROUND/RATIONALE:
The Minimum Data Set (MDS) is a standardized nursing assessment completed for all residents of VA and non-VA nursing homes at the time of admission and regularly thereafter. The MDS has been used within VA for assessment and care planning since 1998. In 2002, VA nursing home care units (NHCUs) also began using the MDS for quality monitoring as well, using standard quality indicators (QIs) already in use by non-VA facilities. However, there has been very little validation of these QIs, and none in VA nursing homes. Thus, as these QIs move into widespread use for quality monitoring and improvement, it is crucial to establish how well they actual represent the quality of nursing home care provided. As a first step toward that goal, this study will validate MDS-based quality indicators in the areas of pain, incontinence, and use of psychotropic medications.
To date, we have accomplished the modeling of risk-adjusted MDS data, developed customized clinical audit tools for the targeted quality indicators, piloted the procedures in 3 community nursing homes, and identified study sites. Staff have been trained in observation techniques. Site recruitment is ongoing. IRB approval has been obtained at 5 sites. We are in process at 7 sites, and preparing for submission at 5 more sites. Additional sites have yet to commit to the project. Travel to individual sites to collect data starts April 1.
OBJECTIVE(S):
The long-range goal of our research program is to improve quality of nursing home care for veterans by fostering use of an evidence-based, user-friendly quality improvement system in VA NHCUs. However, before implementing and evaluating such a system, it is necessary to establish the validity of proposed quality monitoring tools. Thus, the overall goal of the proposed research is to examine the validity of MDS-based QIs to gauge their suitability for routine quality management purposes. Primary research objectives are:
1)to develop and test an empirical strategy for judging the quality of nursing home care based on MDS-based quality indicators, using pain management, incontinence care, and use of psychotropic medications as prototype processes;
2)to establish how strongly QIs in each of the 3 focus areas are affected by nursing home case mix (resident characteristics), and to develop indicator-specific statistical models for risk adjusting each indicator to control those effects, and
3)to identify specific clinical assessment, care delivery, and documentation processes that are most clearly associated with variations in the targeted MDS-based QIs.
METHODS:
These objectives will be pursued in a 3-year study combining statistical analysis and modeling of archival data sets (Objective 2) with electronic and on-site clinical process audits at selected NHCUs across the country (Objectives 1& 3). The project is comprised of three major activities. First, a series of clinical process audits, conducted in NHCUs scoring low (good performers) and high (poor performers) on targeted MDS-based QIs will determine whether those QIs reliably reflect differential care processes. These audits will randomly sample residents who do and do not trigger each relevant indicator, and will combine chart reviews, observations, and in-person interviews to evaluate adherence to best-practice clinical standards. Second, before undertaking those audits, we shall develop state-of-the-art process audit methods for evaluating care delivery and documentation practices relevant to the QIs under study. These will be based on a formal literature review, and will be evaluated and refined by panels of experts in each clinical area of interest. Third, before selecting study sites, we shall also develop and apply statistical risk adjustment strategies to reduce effects of differential resident populations upon the targeted QIs. Risk adjustment methods will apply logistic regression and model-testing methods to a 12-month sample of MDS data for all VA nursing home units nationwide.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
By establishing the validity of selected MDS-based QIs already in use within the VA, this study will facilitate quality management at local, VISN, and national levels.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems
DRE:
Technology Development and Assessment
Keywords:
Long-term care, Nursing, Research measure
MeSH Terms:
none
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