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Facility versus unit level reporting of quality indicators in nursing homes when performance monitoring is the goal.

Norton PG, Murray M, Doupe MB, Cummings GG, Poss JW, Squires JE, Teare GF, Estabrooks CA - BMJ Open (2014)

Bottom Line: To demonstrate the benefit of defining operational management units in nursing homes and computing quality indicators on these units as well as on the whole facility.Unit and facility performance were compared.Our results demonstrate the necessity of considering facility-level and unit-level measurement when calculating quality indicators derived from the RAI-MDS 2.0 data, and quite probably from any RAI measures.

View Article: PubMed Central - PubMed

Affiliation: Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada.

ABSTRACT

Objectives: To demonstrate the benefit of defining operational management units in nursing homes and computing quality indicators on these units as well as on the whole facility.

Design: Calculation of adjusted Resident Assessment Instrument - Minimum Data Set 2.0 (RAI-MDS 2.0) quality indicators for: PRU05 (prevalence of residents with a stage 2-4 pressure ulcer), PAI0X (prevalence of residents with pain) and DRG01 (prevalence of residents receiving an antipsychotic with no diagnosis of psychosis), for quarterly assessments between 2007 and 2011 at unit and facility levels. Comparisons of these risk-adjusted quality indicators using statistical process control (control charts).

Setting: A representative sample of 30 urban nursing homes in the three Canadian Prairie Provinces.

Measurements: Explicit decision rules were developed and tested to determine whether the control charts demonstrated improving, worsening, unchanging or unclassifiable trends over the time period. Unit and facility performance were compared.

Results: In 48.9% of the units studied, unit control chart performance indicated different changes in quality over the reporting period than did the facility chart. Examples are provided to illustrate that these differences lead to quite different quality interventions.

Conclusions: Our results demonstrate the necessity of considering facility-level and unit-level measurement when calculating quality indicators derived from the RAI-MDS 2.0 data, and quite probably from any RAI measures.

No MeSH data available.


Related in: MedlinePlus

Control charts for PAI0X (pain), facility 13 and unit 3.
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BMJOPEN2013004488F3: Control charts for PAI0X (pain), facility 13 and unit 3.

Mentions: Figure 2 demonstrates performance of the indicator PAI0X (prevalence of residents with pain) in facility 13. RAI data were available for 3.25 years, 2008 quarter 4 to 2011 quarter 4. In this case, the facility measurement showed improvement from a rate of around 20% to close to 10%. Similar improvement is seen in unit 3 of this facility as shown in figure 3. In contrast, unit 4 in this facility had a rate of around 30%, with substantial variation, and showed no indication of improvement. While the facility itself appeared to be dealing better with resident pain, unit 4 had high levels of pain which did not appear to change.


Facility versus unit level reporting of quality indicators in nursing homes when performance monitoring is the goal.

Norton PG, Murray M, Doupe MB, Cummings GG, Poss JW, Squires JE, Teare GF, Estabrooks CA - BMJ Open (2014)

Control charts for PAI0X (pain), facility 13 and unit 3.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927709&req=5

BMJOPEN2013004488F3: Control charts for PAI0X (pain), facility 13 and unit 3.
Mentions: Figure 2 demonstrates performance of the indicator PAI0X (prevalence of residents with pain) in facility 13. RAI data were available for 3.25 years, 2008 quarter 4 to 2011 quarter 4. In this case, the facility measurement showed improvement from a rate of around 20% to close to 10%. Similar improvement is seen in unit 3 of this facility as shown in figure 3. In contrast, unit 4 in this facility had a rate of around 30%, with substantial variation, and showed no indication of improvement. While the facility itself appeared to be dealing better with resident pain, unit 4 had high levels of pain which did not appear to change.

Bottom Line: To demonstrate the benefit of defining operational management units in nursing homes and computing quality indicators on these units as well as on the whole facility.Unit and facility performance were compared.Our results demonstrate the necessity of considering facility-level and unit-level measurement when calculating quality indicators derived from the RAI-MDS 2.0 data, and quite probably from any RAI measures.

View Article: PubMed Central - PubMed

Affiliation: Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada.

ABSTRACT

Objectives: To demonstrate the benefit of defining operational management units in nursing homes and computing quality indicators on these units as well as on the whole facility.

Design: Calculation of adjusted Resident Assessment Instrument - Minimum Data Set 2.0 (RAI-MDS 2.0) quality indicators for: PRU05 (prevalence of residents with a stage 2-4 pressure ulcer), PAI0X (prevalence of residents with pain) and DRG01 (prevalence of residents receiving an antipsychotic with no diagnosis of psychosis), for quarterly assessments between 2007 and 2011 at unit and facility levels. Comparisons of these risk-adjusted quality indicators using statistical process control (control charts).

Setting: A representative sample of 30 urban nursing homes in the three Canadian Prairie Provinces.

Measurements: Explicit decision rules were developed and tested to determine whether the control charts demonstrated improving, worsening, unchanging or unclassifiable trends over the time period. Unit and facility performance were compared.

Results: In 48.9% of the units studied, unit control chart performance indicated different changes in quality over the reporting period than did the facility chart. Examples are provided to illustrate that these differences lead to quite different quality interventions.

Conclusions: Our results demonstrate the necessity of considering facility-level and unit-level measurement when calculating quality indicators derived from the RAI-MDS 2.0 data, and quite probably from any RAI measures.

No MeSH data available.


Related in: MedlinePlus