Practice sensitive quality indicators in RAI-MDS 2.0 nursing home data

Abstract

BackgroundIn recent years, improving the quality of care for nursing home residents has generated a considerable amount of attention. In response, quality indicators (QIs), based on available evidence and expert consensus, have been identified within the Resident Assessment Instrument – Minimum Data Set 2.0 (RAI-MDS 2.0), and validated as proxy measures for quality of nursing home care. We sought to identify practice sensitive QIs; that is, those QIs believed to be the most sensitive to clinical practice.MethodWe enlisted two experts to review a list of 35 validated QIs and to select those that they believed to be the most sensitive to practice. We then asked separate groups of practicing physicians, nurses, and policy makers to (1) rank the items on the list for overall “practice sensitivity” and then, (2) to identify the domain to which the QI was most sensitive (nursing care, physician care, or policy maker).ResultsAfter combining results of all three groups, pressure ulcers were identified as the most practice sensitive QI followed by worsening pain, physical restraint use, the use of antipsychotic medications without a diagnosis of psychosis, and indwelling catheters. When stratified by informant group, although the top five QIs stayed the same, the ranking of the 13 QIs differed by group.ConclusionsIn addition to identifying a reduced and manageable set of QIs for regular reporting, we believe that focusing on these 13 practice sensitive QIs provides both the greatest potential for improving resident function and slowing the trajectory of decline that most residents experience.

Nursing Home Residents by Human Immunodeficiency Virus Status: Characteristics, Dementia Diagnoses, and Antipsychotic Use

“…To calculate this outcome, we removed residents with a diagnosis of schizophrenia or bipolar disorder from the denominator, creating an indicator of potentially inappropriate APS medication receipt. A similar indicator has been used in the United States and Canada…”

“…To calculate this outcome, we removed residents with a diagnosis of schizophrenia or bipolar disorder from the denominator, creating an indicator of potentially inappropriate APS medication receipt. A similar indicator has been used in the United States 13 and Canada. 14 Last, to control for changes in prescribing post the US Federal Drug Administration's (FDA's) warnings regarding APS medications, we included indicator variables to designate whether a resident's assessment was completed in calendar years 2000 to 2005, 2006 to 2008, or 2009 to 2010.…”

“…Antipsychotic (APS) medications are frequently used to control behavioral symptoms, such as aggression, despite the known serious complications and adverse consequences (including death) associated with their use . Indeed, the prevalence of APS medications prescribed for residents with dementia is an important NH quality indicator . Furthermore, there are added concerns about APS medication use for HIV+ residents, including drug interactions between second‐generation APS medications and ART use, which may contribute to an increased risk of hyperlipidemia, hypertension, and diabetes …”

“…12 Indeed, the prevalence of APS medications prescribed for residents with dementia is an important NH quality indicator. 13,14 Furthermore, there are added concerns about APS medication use for HIV+ residents, including drug interactions between secondgeneration APS medications and ART use, 15 which may contribute to an increased risk of hyperlipidemia, hypertension, and diabetes. 16 This study uses population-based Medicaid and minimum data set (MDS) data along with data from the Centers for Medicaid and Medicare Services' (CMS') Chronic Condition Warehouse (CCW) to identify a population of HIV+ long-stay NH residents in the 14 US states with the highest HIV prevalence.…”

Improving Nursing Home Care through Feedback On PerfoRMance Data (INFORM): Protocol for a cluster-randomized trial

“…Data for calculating QIs are captured in quarterly assessments completed on all residents [121]. The two practice sensitive (i.e., modifiable by care staff) QIs [122] worsening pain and declining behavioural symptoms will form the focus at unit and facility levels.…”