Inter-rater reliability of nursing home quality indicators in the U.S (original) (raw)
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The Quality of Quality Measurement in U.S. Nursing Homes
Purpose: This article examines various technical challenges inherent in the design, implementation, and dissemination of health care quality performance measures. Design and Methods: Using national and state-specific Minimum Data Set data from 1999, we examined sample size, measure stability, creation of ordinal ranks, and risk adjustment as applied to aggregated facility quality indicators. Results: Nursing home Quality Indicators now in use are multidimensional and quarterly estimates of incidence-based measures can be relatively unstable, suggesting the need for some averaging of measures over time. Implications: Current public reports benchmarking nursing homes' performances may require additional technical modifications to avoid compromising the fairness of comparisons.
Nursing Home Quality Indicators : Their Uses and Limitations
2003
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 ...
Measuring Nursing Home Quality - The Five-Star Rating System
2010
Since 1998, the U.S. Centers for Medicare and Medicaid Services (CMS) has maintained a website, Nursing Home Compare, which provides detailed quality information about every certified nursing home in the country. In December 2008, CMS greatly enhanced the usability of the website by adding an easy-to-understand 5-star rating. Each nursing home receives one to five stars based on performance in each of three key quality domains (health inspections, reported staffing levels, and quality measures derived from mandated assessments of resident health and well-being) plus an overall quality rating. Calculation of ratings requires integration of information from both facility and resident-level data sources. SAS® was used extensively in analysis to support the development of the rating system, and it is currently used to process data to refresh the ratings each month, based on newly collected data in each domain. This presentation describes the integration of data from various sources and ...
International Nursing Review, 2002
Researchers at the University of Missouri-Columbia developed the Observable Indicators of Nursing Home Care Quality instrument to measure the dimensions of nursing home care quality during a brief on-site visit to a nursing home. The instrument has been translated for use in Iceland and used in Canada. Results of the validity and reliability studies using the instrument in 12 nursing homes in Reykjavik, in a large Veterans Home in Ontario with 14 units tested separately, and in 20 nursing homes in Missouri, are promising. High-content validity was observed in all countries, together with excellent inter-rater reliability and coefficient alpha. Testretest reliabilities in Iceland and Missouri were good. Results of the international field test of the Observable Indicators of Nursing Home Care Quality instrument points to the usefulness of such an instrument in measuring nursing home care quality following a quick on-site observation in a nursing facility. The instrument should be used as a facility-wide assessment of quality, rather than for individual units within a facility. We strongly recommend its use by practising nurses in nursing homes to assess quality of care and guide efforts to improve care. We recommend its use by researchers and consumers and further testing of the use of the instrument with regulators.
Identification and evaluation of existing nursing homes quality indicators
Health care financing review, 2002
We summarize work done to identify and evaluate existing quality indicators (QIs) for long-term care (LTC) settings. Indicators operationally defined using routinely collected and computerized patient assessments were identified and then aggregated to characterize the performance of the nursing facility over a specific period of time. Of 143 indicators reviewed, only 22 were recommended for use in comparing performance across facilities. Conceptual and technical issues influence the appropriateness of QIs for different audiences.
Health Services Research, 2008
Objective. To examine associations between nursing homes' quality and publication of the Nursing Home Compare quality report card. Data Sources/Study Settings. Primary and secondary data for 2001-2003: 701 survey responses of a random sample of nursing homes; the Minimum Data Set (MDS) with information about all residents in these facilities, and the Nursing Home Compare published quality measure (QM) scores. Study Design. Survey responses provided information on 20 specific actions taken by nursing homes in response to publication of the report card. MDS data were used to calculate five QMs for each quarter, covering a period before and following publication of the report. Statistical regression techniques were used to determine if trends in these QMs have changed following publication of the report card in relation to actions undertaken by nursing homes. Principal Findings. Two of the five QMs show improvement following publication. Several specific actions were associated with these improvements. Conclusions. Publication of the Nursing Home Compare report card was associated with improvement in some but not all reported dimensions of quality. This suggests that report cards may motivate providers to improve quality, but it also raises questions as to why it was not effective across the board.
The Gerontologist, 2005
Purpose: This study examines the relationship between the first set of quality measures (QMs) published by the Centers for Medicare and Medicaid Services on the Nursing Home Compare Web site and five nursing home structural characteristics: ownership, chain affiliation, size, occupancy, and hospital-based versus freestanding status. Design and Methods: Using robust linear regressions, we examined the values of the QMs at first publication and their change over the first five reporting periods, in relation to facility characteristics. Results: There were significant baseline differences associated with these facility characteristics. Pain, physical restraints, and delirium exhibit a clear downward trend, with differences between the first QM reporting period and the fifth ranging from 12.7% to 46.0%. However, there were only minimal differences in trends associated with facility characteristics. This suggests that the relative position of facilities on these measures did not change much within this time period. The variation by facility type was larger for the shortstay QMs than for the long-stay measures. Implications: Those QMs that show an improvement exhibit it across all types of facilities, irrespective of initial quality levels. Although a number of alternatives may explain this positive trend, the trend itself suggests that report cards, to the extent that they are effective, are so for all facility types but only some QMs.
Practice sensitive quality indicators in RAI-MDS 2.0 nursing home data
BMC Research Notes, 2013
Background: In recent years, improving the quality of care for nursing home residents has generated a considerable amount of attention. In response, quality indicators (QIs), based on available evidence and expert consensus, have been identified within the Resident Assessment Instrument -Minimum Data Set 2.0 (RAI-MDS 2.0), and validated as proxy measures for quality of nursing home care. We sought to identify practice sensitive QIs; that is, those QIs believed to be the most sensitive to clinical practice.
Have Nursing Home Compare quality measure scores changed over time in response to competition?
Quality and Safety in Health Care, 2007
Background: Currently, the Centers for Medicare and Medicaid Services report on 15 Quality Measures (QMs) on the Nursing Home Compare (NHC) website. It is assumed that nursing homes are able to make improvements on these QMs, and in doing so they will attract more residents. In this investigation, we examine changes in QM scores, and whether competition and/or excess demand have influenced these change scores over a period of 1 year. Methods: Data come from NHC and the On-line Survey Certification And Recording (OSCAR) system. QM change scores are calculated using values from January 2003 to January 2004. A series of regression analyses are used to examine the association of competition and excess demand on QM scores. Results: Eight QMs show an average decrease in scores (ie, better quality) and six QMs show an average increase in scores (ie, worse quality). However, for 13 of the 14 QMs these average changes averaged less than 1%. The regression analyses show an association between higher competition and improving QM scores and an association between lower occupancy and improving QM scores. Conclusion: As would be predicted based on the market-driven mechanism underlying quality improvements using report cards, we show that it is in the most competitive markets and those with the lowest average occupancy rates that improvements in the QM scores are more likely. Key points N Nursing homes are somewhat responsive to public reporting of quality indicators-that is, over time, they seek to improve their quality scores. However, this does vary, based on the market in which the nursing homes operate. Access a vast information database with Toll-Free linking ''Toll-free'' linking gives you immediate access to the full text of many of the cited articles in a paper's reference list-FOR FREE. With the support of HighWire's vast journal catalogue, a huge reference library is now open to you. If HighWire hosts the journal, you can view the full text of the referenced article, completely free of charge by following the Free Full Text links in the references. Nursing Home Compare quality measure scores 191