Nursing Home Quality Indicators: Their Uses and Limitations

N Nu ur rs si in ng g H Ho om me e Q Qu ua al li it ty y I In nd di ic ca at to or rs s: : T Th he ei ir r U Us se es s a an nd d L Li im mi it ta at ti io on ns s The views expressed herein are for information, debate, and discussion, and do not necessarily represent official policies of AARP. FOREWORD The question of how to measure and improve the quality of care in nursing homes has challenged policymakers for decades. In 1989, researchers at the Center for Health Systems Research and Analysis (CHSRA) at the University of Wisconsin began to address that question by identifying quality indicators (QI) based on the information federal law requires nursing homes to collect about each nursing home resident. That information, known as the Minimum Data Set (MDS), forms the basis of each resident's care plan, and, as the CHSRA researchers determined, can also be converted into measures that reveal how well a nursing home is caring for its residents. The CHSRA QI consist of specific markers, including the prevalence of pressure ulcers and the use of physical restraints on residents. Today, QI are being developed and implemented for a broad range of purposes in nursing homes. The federal government and many states plan to rely heavily on QI as part of newer systems for monitoring and regulating nursing home quality. The public disclosure of selected " quality measures " marks the latest use of nursing home QI, and in November 2002, the Centers for Medicare and Medicaid Services (CMS) released 10 quality measures to rate and compare nursing homes in every state. This paper describes the development of the federally sponsored nursing home QI, including the recent development and release of the national quality measures. As the public starts to rely on disclosure of specific data about nursing homes in choosing a nursing home and regulators use QI to identify poor quality care, it is important to understand the potentially promising uses and substantial limitations of QI. To that end, this paper was commissioned by the Independent Living and Long-Term Care Team of the AARP Public Policy Institute, and was prepared by Barbara Manard, Ph.D. of the Manard Company, an expert in long-term care policy. This report should contribute to understanding the relevant issues. …