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Nursing home quality measures have four intended purposes: - to give information about the care at nursing homes to help you choose a nursing home for yourself or others;
- to give you information about the care at nursing homes where you or family members already live;
- to get you to talk to nursing home staff about the quality of care; and
- to give data to the nursing home to help them with their quality improvement efforts
The current quality measures have been chosen because they can be measured and don't require nursing homes to prepare additional reports. They are valid and reliable. However, they are not benchmarks, thresholds, guidelines, or standards of care. They are based on care provided to the population of residents in a facility, not to any individual resident, and are not appropriate for use in a litigation action. These quality measures were selected because they are important. They show ways in which nursing homes are different from one another. There are things that nursing homes can do to improve their percentages. The quality measures have been checked and are based on the best research currently available. As this research continues, scientists will keep improving the quality measures on this website. The nursing home quality measures come from resident assessment data that nursing homes routinely collect on the residents at specified intervals during their stay. These measures assess the resident's physical and clinical conditions and abilities, as well as preferences and life care wishes. These assessment data have been converted to develop quality measures that give consumers another source of information that shows how well nursing homes are caring for their residents' physical and clinical needs. Some Minimum Data Set (MDS) items used to calculate the enhanced quality measures consider the resident's condition during previous days prior to the assessment date. The following table provides these "observation" or "look back" time frames. | Quality Measures | MDS Observation Time Frame * | Long Term Measures | Percent of Long-Stay Residents Given Influenza Vaccination During the Flu Season | October 1 thru March 31 | Percent of Long-Stay Residents Who Were Assessed and Given Pneumococcal Vaccination | Looks back 5 years | Percent of Residents Whose Need for Help With Daily Activities Has Increased | Looks back 7 days | Percent of Residents Who Have Moderate to Severe Pain | Looks back 7 days | Percent of High-Risk Residents Who Have Pressure Sores | Looks back 7 days | Percent of Low-Risk Residents Who Have Pressure Sores | Looks back 7 days | Percent of Residents Who Were Physically Restrained | Looks back 7 days | Percent of Residents Who are More Depressed or Anxious | Looks back 30 days | Percent of Low-Risk Residents Who Lose Control of Their Bowels or Bladder | Looks back 14 days | Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder | Looks back 14 days | Percent of Residents Who Spent Most of Their Time in Bed or in a Chair | Looks back 7 days | Percent of Residents Whose Ability to Move About in and Around Their Room Got Worse | Looks back 7 days | Percent of Residents with a Urinary Tract Infection | Looks back 30 days | Percent of Residents Who Lose Too Much Weight | Looks back 30 days | Short-Stay Measures | Percent of Short-Stay Residents Given Influenza Vaccination During the Flu Season | October 1 thru March 31 | Percent of Short-Stay Residents Who Were Assessed and Given Pneumococcal Vaccination | Looks back 5 years | Percent of Short-Stay Residents With Delirium | Looks back 7 days | Percent of Short-Stay Residents Who Had Moderate to Severe Pain | Looks back 7 days | Percent of Short-Stay Residents With Pressure Sores | Looks back 7 days |
* When multiple MDS items with more than one "look back" timeframes are used to
calculate the measure, this table displays the longest "look back" timeframe. The quality measures, developed under CMS contract to Abt Associates and a research team led by Drs. John Morris and Vince Mor, have been validated and are based on the best research currently available. These quality measures meet four criteria. They are important to consumers, are accurate (reliable, valid and risk adjusted), can be used to show ways in which facilities are different from one another, and can be influenced by the provision of high quality care by nursing home staff. From the beginning of this Initiative, CMS has said that the quality measures are dynamic and will continue to be refined as part of CMS's ongoing commitment to quality. In the Fall 2003, the National Quality Forum (NQF) recommended a final set of measures endorsed by their consensus process that will become the enhanced set of publicly reported quality measures available on Nursing Home Compare starting January 22, 2004. The National Quality Forum is a voluntary standard setting, consensus-building organization representing providers, consumers, purchasers and researchers. The periods of time for the quality measures follow: - For the chronic care measures, calculations are based on any resident with a full or quarterly MDS in the target quarter.
- For post-acute care measures, calculations are based on any resident with a 14-day PPS MDS in the 2 consecutive target quarters.
The downloadable quality measure user manual provides detailed quality measure information and other research reports are available on Nursing Home Archives. Additional downloadable information includes snapshot quality measures definitions, quality measure consumer language and the National Quality Forum nursing home press release. Quality Measures Under Development CMS contracts with research organization to test and recommend new approaches for quality measurement and data collection. There are downloads that provide reports on quality of life measures for nursing home, nursing home staffing and post acute research activities. These research reports provide CMS with ideas for future quality measures. Development of Staffing Quality Measures – Phase I The Final Report from the Development of Staffing Quality Measures – Phase I is found in the download section. This report includes an Overview of the files, an Executive Summary, the Final Report and Appendices, the Nursing Home Staffing Database and Data Dictionary, the Literature Review, and the Stakeholder Meeting Summary. This phase of the project was completed July 2005. Development of Staffing Quality Measures – Phase I Continuation currently underway is expected to conduct a feasibility study and test specified payroll data reporting. This current phase is expected to be completed by March 2008. Pay for Performance CMS is considering implementing a pay for performance demonstration in nursing homes at this time and no details are available. Quality Improvement Under the direction of CMS, the quality improvement organizations (QIO) program consists of a national network of fifty-three QIOs responsible for each U.S. state, territory, and the District of Columbia. QIOs work with consumers, physicians, hospitals, and other caregivers to refine care delivery systems to make sure patients get the right care at the right time, particularly among underserved populations. The program also safeguards the integrity of the Medicare trust fund by ensuring payment is made only for medically necessary services, and investigates beneficiary complaints about quality of care.
Page Last Modified: 09/30/2008 2:16:55 PM
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