NHCQE
Nursing Home Case Mix and Quality Demonstration Evaluation
(SNF PPS Demonstration Evaluation)
Funded by: Health Care Financing Administration
Subcontract from: Abt Associates
Project Period: 10/94 - 9/99
Two projects were conducted as part of the larger evaluation to determine how
prospective case-mix adjusted SNF payments for Medicare patients impacts access,
quality, and costs of care. The subcontract specifically addressed changes in
resident outcomes resulting from changes in the payment process and the state
survey process. NHCQE DT: Using medical records, retrospective data was
collected on approximately 5,000 patients at 60 SNFs in 5 of the 6 demonstration
states to assess the impact of case-mix adjusted payments on: skilled services
provided, hospitalization rates, provision of rehabilitation services,
rehabilitation outcomes, and rates of discharge to the community. Information
abstracted included patient demographics, comorbidities, disease severity
indicators, quality of care indicators, discharge/transfer frequencies, and
therapy time. Additional information was collected on the care and services
received by residents transferred to hospital within seven days of admission,
and residents who had pneumonia, UTI, or CHF within 90 days of admission.
NHCQE QI: Additionally, replicated surveys were conducted at 40 facilities
to determine whether or not the use of quality indicators in the survey process
improved the detection of health care delivery problems and ultimately improved
resident outcomes.
Key Staff: Kramer, Hutt, Ecord, Frederickson, Eilertsen
Journal Articles:
Hutt E, Frederickson EB, Ecord MK, KHutt E, Ecord MK, Eilertsen TB, Frederickson EB, Kowalsky JC, Kramer AM. "Prospective Payment for Nursing Homes Increased Therapy Provision without Improving Community Discharge Rates." Journal of the American Geriatrics Society 49(8):1071-1079, 2001.
Hutt E, Ecord MK, Eilertsen TB, Frederickson EB, Kramer AM. "Precipitants of Emergency Room Visits and Acute Hospitalization in Short-Stay Medicare Nursing Home Residents." Journal of the American Geriatrics Society 50(2):223-229, 2002.
Research Monographs:
Hutt E, Ecord MK, Frederickson EB, Eilertsen TB, Kramer AM. "Effect of Prospective Payment on Therapy Provision and Community Discharge for Patients With a Minimum Data Set," in Kramer AM, Eilertsen TB, Hutt E, Frederickson EB, Ecord MK, Kowalsky, CJ, Nursing Home Case Mix and Quality Demonstration Evaluation Final Report Volume 2: Effects on Outcomes and Quality, HCFA, Washington, D.C., 2000
Kramer AM, Lin MK, Louwe HM, Ecord MK, Kowalsky JC. "Nursing Home Case Mix and Quality Demonstration Evaluation. Final Report Volume 3: Nursing Home Survey Validity." 2000.
Kramer AM, Eilertsen TB, Hutt E, Frederickson EB, Ecord MK, Kowalsky JC. "Nursing Home Case Mix and Quality Demonstration Evaluation. Final Report Volume 2: Effects on Outcomes and Quality." University of Colorado Denver, Denver Colorado. May 2001.
Policy Presentations & Congressional Testimony:
"Outcome Indicators and the Survey Process for Subacute and Long-Term Care in Nursing Facilities." Health Care Financing Administration. Baltimore, Maryland. February 13, 1997.
Testimony before Senate Special Committee on Aging Hearing. "The Nursing Home Initiative: Results at Year One." Washington, D.C.. June 30, 1999.
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