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Quality indicators: the new survey tool.

Much interest has been generated in nursing homes using quality indicators (QIs) to identify potential quality concerns. Thanks to HCFA's multiyear research partnership with the University of Wisconsin's Center for Health Systems Research and Analysis, Dr. David Zimmerman's work on QIs has provided a foundation for both internal and external quality assessment. The result is a newly emerging use of QIs by state surveyors to identify, investigate and evaluate potential quality problems before, during and between surveys.

Dr. Zimmerman and his research team developed and tested the use of QIs drawn from a subset of responses from the Resident Assessment Instrument. The items were selected based both upon their importance as measures of resource utilization and their implications for measuring quality performance. The QIs denote either the existence or absence of potentially poor care processes or outcomes.

The accompanying table presents the program's 12 domains or areas of measurement, containing 30 indicators, cross-referenced to specific tag numbers for surveyor evaluation.

While the initial prevalence of conditions is compiled based upon resident-specific information, the results can be totalled to define the facility's overall performance and compared with other facility norms; e.g., statewide facility average, other facilities of similar size or other facility characteristics. Although an individual facility may exceed an established threshold, [TABULAR DATA OMITTED] such as the statewide average, the message for surveyors is that they should not automatically assume that a problem exists until they have investigated further and learned how the problem is being addressed. An outlier QI does not always mean that a deficiency should be cited.

So much for what surveyors may do with QI information. What can facilities do to prepare for the eventual application of QIs to the survey process? Facilities should already be collecting QI data through their Quality Assurance committee efforts and, probably, with the help of their MDS/Care Plan software vendors. Now is the time to carefully analyze the resulting data and learn where your facility's weaknesses lie.

Once you have prepared initial QI scores for your facility, you might learn that your facility's comprehensive assessment process is not as accurate as desired. You might also learn that some services, such as restorative programs, are not being provided as aggressively as possible. You may further learn that care practices in specific areas, such as skin care, need to be dramatically improved to avoid receiving future deficiencies.

In the case of QI scores, knowing now is definitely better than finding out from surveyors later.

Beth A. Klitch, FACHCA, is President of Survey Solutions, Inc., Columbus, OH. For further information, (614)488-1280, or send correspondence c/o Nursing Homes Magazine.
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Title Annotation:nursing homes
Author:Klitch, Beth A.
Publication:Nursing Homes
Date:Nov 1, 1997
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