National process launched to ensure
nursing home quality of care
The 17,000 nursing homes in the United States are surveyed annually by state health departments to assure the quality of care provided to some of the frailest Americans. Under the leadership of Dr. Andrew Kramer, researchers in the Division of Health Care Policy and Research (HCPR) at UCD have worked for more than a decade on developing a more reliable and beneficial process for assessing nursing home quality.
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| HCPRColorado Team: (left to right) Martha Elder; Karen Alms; Danielle Holthaus; Sheryl Faut; Jane Hermanson; Peggy Williams; Andrew Kramer; Staci Morley-Young; Martha Powell; Laurel Brown; Julie Slater. Not shown: Evelyn Casiano; Daniel Sandy; John Rose |
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| HCPRClassroom Training: Brown and Staci Morley-Young introduce the QIS software. |
Culmination of their efforts is a five-state demonstration of a new survey process, which began by training surveyors from Connecticut, Kansas, and Ohio, and numerous representatives from the federal government in Denver the week of Sept. 26. Contracts totaling in excess of $1.8 million from the Centers for Medicare & Medicaid Services (CMS) were awarded to HCPR to conduct the training, provide technical assistance, and participate in the evaluation for this demonstration.
More than 160 specific quality measures are used to assess quality of care based on information obtained from surveyors through observation, resident interview, family interview, staff interview, and chart review, as well as facility-reported information. This Quality Indicator Survey (QIS) differs from the existing process where information is gathered by surveyors in text form, and judgments are made about quality of care without reliance on specific measures. The QIS involves rigorous sampling, automation using tablet PCs, and customized software to guide nursing home surveyors through a structured investigation.
In developmental testing, the QIS was found to improve consistency and accuracy of problem identification, review quality in a more comprehensive manner, enhance documentation by organizing findings through automation, and focus review resources on facilities with the largest numbers of quality concerns.
The demonstration will result in a large-scale test with surveyors conducting surveys of record while undergoing an independent systematic evaluation. Ultimately, if successful, CMS is prepared to roll the survey out to all 5,000 surveyors in all states beginning in fiscal year 2006/2007. The tools used for collection of quality of care information would also be made available to nursing homes for ongoing quality improvement activities.
