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Coming: a national data bank for quality improvement.

Now there is a target date -- or year -- for the long- anticipated MDS- based national data base from the Health Care Financing Administration (HCFA): 1995. Some time that year, in some way, and in some format (details are still being worked out), nursing homes' resident assessment data will be funneled to HCFA. HCFA staff are developing a system for the MDS data base, but stress that final decisions have not yet been made. Specific details will be published soon in a Final Rule. In general, HCFA is working toward developing a process to analyze the data and send them back to nursing homes in the form of reports showing how well they are doing, comparatively speaking.

In short, depending on your point of view, you -- the nursing home administrator -- are getting either an incentive to upgrade your facility to a higher standard of quality, or else a nervous-making "report card" putting your claims of quality care to the test.

Recently NURSING HOMES asked a HCFA spokesperson for further details on this national data bank "work-in-progress." As it stands now, a group of "providers, consumers, researchers, State agencies and Federal staff" are involved in the early planning stages. The planners are discussing how the data will flow, in what format, and how comparative information will be reported back to facilities. There is every expectation that the comparative information will be made public -- "usefulness to consumers is one of the greatest values of this," said the HCFA spokesperson -- but HCFA adds that it is sensitive to providers' concerns about potential unfairness and misinterpretation of such reports.

As anticipated, HCFA will require facilities to provide computerized MDS data for all residents, but facilities will have a variety of options by which to do this. Clinicians or clerical staff may use computerized software to enter the data, or contract with an outside vendor to keypunch the data from a hard copy of the assessment forms. Once the data bank is underway, facilities will have to be geared up to report to HCFA or States on at least a quarterly basis. This will not, however, relieve nursing homes of the responsibility for undergoing periodic surveys. And, about those surveys, there is good news and bad news.

The bad news is that the frequency of surveys -- mandated by law to be conducted a minimum of every 15 months -- is not expected to decline. The good news, according to HCFA, is that the MDS data should allow surveys to be more targeted, focusing on the specific potential resident care problems identified through the outcome data found on the MDS, rather than the broader, "shotgun-type" approach now commonly experienced.

What (aside from more targeted surveys) are the benefits of all this to the nursing home? According to HCFA, computerized MDS data should allow nursing homes to more closely monitor resident outcomes and to understand the effect of various care practices on those outcomes. Also, a clearer understanding of what, indeed, constitutes quality care -- so often, seemingly, a moving target -- and what specifically has to be done to achieve it, should help nursing homes improve while experiencing minimal confusion and false starts. Another benefit, particularly for the nursing homes that do comparatively well in the quality ratings, will be "bragging rights" for use in their marketing materials (though HCFA itself, of course, doesn't make much of this). A third benefit -- and one that HCFA says is another primary purpose of the data bank -- is the development of solidly grounded research further defining quality long-term care. "There probably isn't a more potentially rich data base in health care," said the spokesperson.

All of which means that what everyone anticipated would happen, when OBRA-based assessment and care planning came about, is finally happening and coming to your local nursing home next year. And if you want a say in what it looks like in its final form, now is the time to let HCFA know, via your local and State professional organizations.
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Title Annotation:How to be a Quality Standout: Adventures in Nursing Homes CQI
Author:Peck, Richard L.
Publication:Nursing Homes
Date:Mar 1, 1994
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