Objective
This quality improvement (QI) project was initiated to understand what differentiates
nursing homes (NHs) that perform well on publicly reported Centers for Medicare and
Medicaid Services (CMS) Quality Measures (QMs). The intent was to assist NH staff
to direct QI efforts to positively impact QM rates. A key step was to determine if
any resident or facility characteristics might account for some of the variability
in QMs of high-risk pressure ulcers (HRPrUs), low-risk incontinence (LRI), and Activities
of Daily Living (ADL) decline, beyond those already adjusted for by CMS.
Design
Observational Study.
Setting and Participants
The setting was 147 NHs across 12 northeast states owned by 1 for-profit, multifacility
organization in 2006 and 2007.
Intervention
None
Measurements
Minimum Data Set (MDS), patient admission information, facility staffing metrics,
and CMS QM data.
Results
Relationships of facility and resident characteristics to QMs were evaluated using
regression analyses performed separately for 2006 and 2007. Among factors found consistently
to be significant (P ≤ .05) for HRPrUs were percent admissions with pressure ulcers and percent residents
with end-stage disease. For LRI, there was significant association with percent residents
readmitted and percent incontinent of bladder on admission. ADL decline showed significant
associations with licensed nurse turnover and facilities in specific states.
Conclusion
Several resident and facility factors were associated with QMs beyond those previously
adjusted for by CMS. With introduction of MDS 3.0, we suggest further exploration
of resident and facility factors identified in this study.
Keywords
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Article info
Publication history
Published online: April 05, 2010
Footnotes
Funding for this study was provided by Genesis HealthCare, Inc. We thank the staff, leadership, and Board of Directors of Genesis Healthcare for their initiative in supporting this study.
Identification
Copyright
© 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
