Coleman EA, Krammer AM, Johnson M, Eilertsen TB, Holthaus D; Association for Health Services Research. Meeting.

Abstr Book Assoc Health Serv Res Meet. 1999; 16: 78.

Center for Aging Research, University of Colorado Health Sciences Center, Denver 80206, USA.

BACKGROUND: Traditional approaches to quality measurement in post-acute care have been largely setting-specific and relied upon adaption of existing measures employed in long-term care. Yet the spectrum of care required for patients in post-acute care settings has shifted away from long-term care and towards more acute care. Further, the increasing severity and complexity of illness managed in the post-acute care settings as well as the number of care transitions across post-acute care settings necessitates a set of new post-acute care measures that incorporate both acute/disease-specific measures in addition to more global functional measures. RESEARCH OBJECTIVE: To identify measures that more appropriately assess the quality of care provided in post-acute care settings. STUDY DESIGN: For the purpose of this study, post-acute care was defined as care provided in the 30 days after an acute event that is severe enough to have required acute hospitalization. The care settings include skilled nursing facilities, home health agencies and rehabilitation hospitals. In the initial phase of the present study, review of claims analyses and the medical literature were used to select four representative tracer conditions designed to illustrate the challenges of quality measurement in post-acute care settings. The selection criteria for the tracer conditions included: 1. Care provided across different post-acute care settings; 2. High volume conditions; 3. Medicare service use patterns and; 4. Analytic practicality. After extensive evaluation, the conditions that met these criteria included: Pneumonia, Congestive Heart Failure, Back and Neck Conditions (medical and surgical), and Stroke. In the second phase, a focused synthesis of the medical literature and clinical experience was conducted in order to compile a list of proposed quality indicators for each of the four tracer conditions. In the third phase, an Expert Clinical Panel was convened which included a geriatrician, physiatrist, psychiatrist, physical therapist, occupational therapist, speech therapist, home health nurse, skilled nursing facility nurse, rehabilitation nurse and physician content experts for each of the four selected conditions. A modified Delphi approach was employed for reviewing, rating and determining optimal quality indicators. PRINCIPAL FINDINGS: The quality indicators that received the highest ratings represented a blend of acute/disease-specific and more global/functional measures. These indicators related to quality both in terms of process of care and outcome. The majority of these indicators required data from patient self-report. During the accompanying discussion, a high-level of concern was raised with respect to the adaption of measures used in different settings (e.g. outpatient) to the post-acute care population, particularly with regard to "floor effects" and responsiveness to change. The care of patients with pneumonia in the post-acute care setting provides an illustrative example. Among the top 20 rated indicators (out of a total of 110), there was comparable representation of acute/disease specific indicators (e.g. dyspnea, cough, fatigue, physician visits for pneumonia, and immunization status) and more global indicators (physical function, health related quality of life, patient satisfaction, and role resumption). CONCLUSIONS: The rapid expansion of post-acute care requires the development of a unique quality measurement strategy. Standard measures of quality to assess post-acute care are not well specified and existing instruments are not adequate. While expert clinicians generally agreed on measuring functional outcomes, quality of life, and satisfaction for all four conditions, they also recommended various disease-specific measures relating to care process and physiologic outcomes. Further, a central role for patient self-reported quality measures was strongly endorsed. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Post-acute care services are used extensively for Medicare patients and expenditures are the fastest growing in the Medicare program, consuming an increasing portion of Part A expenditures. In this project, we have developed a set of quality of care measures uniquely tailored to Medicare post-acute care services provided in skilled nursing facilities, home health agencies, and rehabilitation hospitals or across multiple settings. These measures have been selected in preparation for subsequent evaluation of post-acute care quality in both fee-for-service and managed care settings.

Publication Types:

• Meeting Abstracts

Keywords:

• Data Collection
• Evaluation Studies
• Health Services Needs and Demand
• Humans
• Long-Term Care
• Managed Care Programs
• Medicare
• Quality Indicators, Health Care
• Research Design
• Skilled Nursing Facilities
• Weights and Measures
• economics
• therapy
• hsrmtgs

Other ID:

• HTX/20602761

UI: 102194450

From Meeting Abstracts