Abstract
The initiative described here aims to identify quality indicators (QIs) germane to
the international practice of primary care providers (PCP) in post-acute and long-term
care in order to demonstrate the added value of medical providers in nursing homes
(NHs). A 7-member international team identified and adapted existing QIs to the AMDA
competencies for medical providers. QI sources included the ACOVE 3 Quality Indicators
(2007), NH Quality Indicators (2004), NH Residential Care Quality Indicators (2002),
and AGS Choosing Wisely (2014). We recruited a technical expert panel (TEP) consisting
of 11 panelists from the US, Canada, and the European Union, selected for their knowledge
and leadership in post-acute and long-term care. The TEP, using a RAND Modified Delphi
approach, provided pre-meeting ratings, discussed items in-person for clarification,
and re-rated items following discussion. When panelists rated more than 1 option for
a particular QI as valid and feasible, the most stringent option was selected for
inclusion in the final candidate set of QIs. Panelists confidentially rated an initial
103 items on validity and feasibility of implementation. During the meeting, panelists
added 18 QIs and modified 18. In post-meeting analysis, we eliminated 7 QIs rated
not valid and 11 QIs for which a more stringent QI was rated valid and feasible. This
resulted in a final set of 95 QIs rated valid and feasible and 8 rated valid but not
feasible. This set of QIs for PCPs in the NH identified practices in which provider
engagement adds value through expertise in geriatric syndromes, employing evidence-based
practice, advocating for residents, delivering person-centered care, facilitating
advance care planning, and communicating effectively to coordinate care. Next steps
include pilot testing and evaluating the association between adherence to QIs, PCP
staffing models, and better outcomes.
Keywords
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Article info
Footnotes
The authors declare no conflicts of interest.
This work was supported by a grant from the Morris Justein Family Charitable Foundation to Baycrest Health Sciences, an affiliate of the University of Toronto.
The authors declare no conflicts of interest.
Identification
Copyright
Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
