Background
Behavioral and psychological symptoms associated with dementia are common in nursing
home residents. Quality indicators (QI) assessing quality of care for these residents
are minimally risk adjusted and can provide inaccurate information regarding the quality
of care provided by the facility.
Objective
Evaluate the performance of a new QI for the incidence of worsening behaviors in nursing
home residents with behavioral and psychological symptoms association with dementia.
Design
Retrospective cohort study.
Setting
A total of 381 Minnesota nursing homes with 26,165 residents.
Data Sources
Minimum Data Set records for the first 2 calendar quarters of 2008.
Measurements
We calculated incidence of worsening behaviors QI by comparing items from the “behavior”
section of the Minimum Data Set records from 2 consecutive quarters and reported the
incidence rates by both the residents’ level of cognitive impairment and the presence
or absence of special care unit for dementia (SCU).
Results
The incidence rates of the worsening behavior QI in SCU ranged from 14% in residents
with very severe cognitive impairment (a cognitive performance score = 6) to 30% in
those with moderate cognitive impairment (a cognitive performance score = 3). The
incidence QI rates among residents residing in conventional unit ranged from 15% among
those with very severe cognitive impairment to 20% among those with moderate cognitive
impairment. These differences in QI rates between the 2 units were statistically significant
with a P value = .001. After risk adjustment for level of cognitive impairment, number of
facilities with SCUs that flagged for problem behaviors dropped from 18.4% to 12.4%
and the number of conventional units in the low-risk category from 16.8% to 4.7%.
Conclusion
Resident cognitive function and the facility utility of SCU are associated with worsening
behavior QI and should be adjusted for in any nursing home quality reporting measure.
Keywords
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References
- Efficacy of memantine on behavioral and psychological symptoms related to dementia: a systematic meta-analysis.Ann Pharmacother. 2008; 42: 32-38
- Behavioral symptoms in residential care/assisted living facilities: prevalence, risk factors, and medication management.J Am Geriatr Soc. 2004; 52: 1610-1617
- Prevalence of physical and verbal aggressive behaviours and associated factors among older adults in long-term care facilities.BMC Geriatr. 2005; 5: 13
- Characteristics associated with behavioral symptoms related to dementia in long-term care residents.Gerontologist. 2005; 45: 56-61
- Associations between the working characteristics of nursing staff and the prevalence of behavioral symptoms in people with dementia in residential care.Int Psychogeriatr. 2008; 20: 764-776
- The quality of antipsychotic drug prescribing in nursing homes.Arch Intern Med. 2005; 165: 1280-1285
- Prevalence and treatment of neuropsychiatric symptoms in advanced dementia.J Gerontol Nurs. 2008; 34 (quiz 6–7): 8-15
- Staff turnover and quality of care in nursing homes.Med Care. 2005; 43: 616-626
- Special care units for dementia individuals with behavioural problems.Cochrane Database Syst Rev. 2009; (4):CD006470
- Improving the quality of long-term care with better information.Milbank Q. 2005; 83: 333-364
- Improving nursing home quality of care through outcomes data: the MDS quality indicators.Int J Geriatr Psychiatry. 2003; 18: 250-257
- Nursing home quality indicators: Implications for residents with Alzheimer’s and related disorders.in: Vellas B. Research and Practice in Alzheimer’s Disease and Cognitive Decline. Serdi, Toulouse, France2006: 316-321
- Minnesota’s nursing facility performance-based incentive payment program: An innovative model for promoting care quality.Gerontologist. 2010; 50: 556-563
- The quality of quality measurement in US nursing homes.Gerontologist. 2003; 43: 37-46
- Development and testing of nursing home quality indicators.Health Care Financ Rev. 1995; 16: 107-127
- MDS Cognitive Performance Scale.J Gerontol. 1994; 49: M174-M182
- Improving quality assessment through multilevel modeling: The case of nursing home compare.Health Serv Res. 2007; 42: 1177-1199
- Cognition and behaviour are independent and heterogeneous dimensions in Alzheimer’s disease.J Neurol. 2004; 251: 688-695
- Association between cognitive function, behavioral syndromes and two-year clinical outcome in Chinese subjects with late-onset Alzheimer’s disease.Int Psychogeriatr. 2006; 18: 517-526
- The spectrum of behavioral changes in Alzheimer’s disease.Neurology. 1996; 46: 130-135
- Relationship of behavioral and psychological symptoms to cognitive impairment and functional status in Alzheimer’s disease.Int J Geriatr Psychiatry. 2000; 15: 393-400
- The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes.Int J Geriatr Psychiatry. 2007; 22: 843-849
- Psychopathological features in Alzheimer’s disease: Course and relationship with cognitive status.J Am Geriatr Soc. 2003; 51: 953-960
- Behavioral and psychological symptoms of dementia in relation to level of cognitive impairment.Int Psychogeriatr. 2008; 20: 777-789
- Evaluating rural nursing home environments: Dementia special care units versus integrated facilities.Aging Ment Health. 2004; 8: 256-265
- Does risk adjustment of the CMS quality measures for nursing homes matter?.Med Care. 2008; 46: 532-541
- National release of the nursing home quality report cards: Implications of statistical methodology for risk adjustment.Health Serv Res. 2009; 44: 79-102
- Nursing homes’ response to the nursing home compare report card.J Gerontol B Psychol Sci Soc Sci. 2007; 62: S218-S225
- Measurement sensitivity and the Minimum Data Set depression quality indicator.Gerontologist. 2001; 41: 401-405
- Measuring behavioral and mood disruptions in nursing home residents using the Minimum Data Set.Outcomes Manag Nurs Pract. 2001; 5: 28-35
- Teaching and maintaining behavior management skills in the nursing home.Gerontologist. 2002; 42: 487-496
- Validation of the Minimum Data Set Cognitive Performance Scale: Agreement with the Mini-Mental State Examination.J Gerontol A Biol Sci Med Sci. 1995; 50: M128-M133
- Validity and responsiveness of the Minimum Data Set.J Am Geriatr Soc. 1999; 47: 1000-1004
- Nursing home assessment of cognitive impairment: Development and testing of a brief instrument of mental status.J Am Geriatr Soc. 2008; 56: 2069-2075
Article info
Publication history
Published online: January 03, 2011
Footnotes
This research was funded by grant support from the Alzheimer's Association Grant #IIRG-07-59504: Developing Comprehensive Dementia-specific Nursing Home Quality Indicators.
A.N. is on speaker's bureau at Pfizer, Inc. No conflict reported (A.N.); M.B. Received research suppport from Pfizer, Inc., Forest Pharmaceuticals and Novartis, and is on speaker's bureau at Pfizer, Inc; G.A. and A.P. have no conflicts to report.
Identification
Copyright
© 2011 Published by Elsevier Inc.
