AAHSA's "MDS-Based Quality Improvement System." (American Association of Homes and Services for the Aging)(Not-For-Profit Report)

MDS data: you collect them, you key them into your computer system - but then what? Data amount to little more than irrelevant facts and figures unless they're put to some sort of meaningful use - improving quality of care, for example.

This is the premise behind the new MDS-Based Quality Improvement System (MDS-QIS) being offered by AAHSA, a set of tools designed to help providers objectively analyze and improve quality of care using the data they're already required to collect.

The MDS-QIS is the first of AAHSA's SmartSystems, a number of new initiatives designed to give member facilities the ability to provide quality service, achieve high resident and family satisfaction, control costs and compete in a managed care environment.

MDS-QIS was developed and is administered by the University of Wisconsin's Center for Health Systems Research Analysis (CHSRA), under the direction of David Zimmerman, PhD. The Center has a long history of contract work with the Health Care Financing Administration (HCFA), most recently developing HCFA's Quality Indicators and currently under contract to evaluate its survey and enforcement process.

MDS-QIS works with existing MDS software that can output data in the HCFA draft format for electronic transmission, explains Chuck Tremper, AAHSA's Chief Information Officer. User-facilities send their MDS data via disk to CHSRA. The Center then analyzes the data and provides the facility with the system's first and central component, a series of detailed quarterly Facility/Resident Level Quality Improvement Reports.

The first set of these reports is resident-specific, providing analyses of 12 clinical and functional "domains" for each resident. Each of these domains is broken down by risk factors into several specific indicators, ([ILLUSTRATION OMITTED], page 24) showing the provider where to focus efforts toward improvement, as well as providing independent validation of areas of excellence.

Using the same domains and indicators, a second set of reports identifies patterns within the facility, while a third set of reports compares the user-facility's data with those of peer facilities. This provides the nursing home with a unique and effective way to assess its strengths and weaknesses while sizing up the market. In addition, in states where RUGS III data are available, the program uses the MDS data to provide facilities with an assessment of their resident population by the RUGS III groupings.

The three additional components of the MDS-QIS consist of tools designed to help providers take action based on the data analyzed, rounding out what is intended to be a comprehensive, proactive quality of care program. These include:

The Protocols for Determining Problems component, a series of assessment protocols designed to determine whether or not problems identified in the Facility/Resident Level Quality Improvement Reports are, in fact, real problems and, if they are, why they are occurring. This is accomplished by guiding the user through an analysis designed to uncover hidden sources of trouble.

The system's General Quality Improvement Guidelines provide training for the development of "real world" quality improvement programs to address apparent problems. The final component, the Quality Improvement Technical Assistance Tools, provides lists of resources for specific conditions.

All in all, says AAHSA President Sheldon Goldberg, "the system is intended to help providers take a proactive approach to quality improvement by identifying potential problem areas and taking corrective action before the survey process," and by basing clinical and management decisions on a clear understanding of the facts. At the same time, the system provides an effective means of documenting a facility's quality of care, providing validation of that quality for third-party payers and developing a baseline for future comparisons.

After a successful trial run of the MDS-QIS in Wisconsin, AAHSA has joined with the Wisconsin project and is now making the system available through affiliated state associations. Tremper notes that some state affiliates may make the system available to for-profit as well as not-for-profit facilities.

Other SmartSystem initiatives - a resident satisfaction survey tool, cost accounting software, and a case study approach to quality improvement - will be rolled out to member facilities during 1997.