Indicators called a success for measuring quality
The quality indicators of the Center for Health Systems Research and Analysis (CHSRA), based at the University of Wisconsin-Madison, are being called a success after nearly a decade of use. The developers of the indicators say the development process should be a model for the creation of other quality indicators. The CHSRA developed the indicators in the 1990s as part of a project for the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services) to assess the quality of care in nursing homes.
The university’s assessment calls the indicators a success in helping assess quality for more than two million residents living in the nation’s 17,000-plus nursing homes. All of those nursing homes and others in about a dozen countries worldwide apply the quality indicators. The CHSRA indicators essentially are mechanisms that state and federal inspectors, accreditation agencies, and nursing homes themselves use to identify areas of nursing home care that need review for improvement, says David Zimmerman, CHSRA director and UW-Madison adjunct professor of industrial engineering.
The 24 indicators cover 12 areas of care: accidents, behavioral and emotional patterns, clinical management, cognitive patterns, elimination and incontinence, infection control, nutrition and eating, physical functioning, psychotropic drug use, quality of life, sensory functioning, and skin care. The data they generate are based on facilities’ mandatory quarterly assessments of each resident, called the Minimum Data Set (MDS).
For example, under the "clinical management" quality indicator, an excessive number of residents who received nine or more different medications during the most recent assessment period would raise a red flag.
"Just being on nine or more medications doesn’t necessarily mean that you’ve got bad drug policy," Zimmerman says. Instead, the indicator might mean that the nursing home should be aware that the chances are higher for such residents to experience adverse reactions, which, if not identified and acted on quickly, might require hospitalization.
When the project first began, CHSRA staff identified nearly 200 indicators based on nursing home data in five states. To determine whether the indicators were valid measures of quality, CHSRA staff then sent clinical teams into nursing homes in four states to assess care and compare the results to what the indicators predicted. Later, to accommodate a new version of the MDS, the project team reduced the number of indicators to its current 24.
Now the Centers for Medicare and Medicaid Services is using the indicators as the basis for a second-generation set of quality mechanisms that would apply not only to nursing homes, but also to other settings, such as postacute care. Zimmerman is consulting for the project.
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