Developing a quality measurement tool and reporting format for long- term care.
BACKGROUND
Quality measurement in long term care (LTC) presents many challenges: the lack of a uniform definition of quality, the existence of multiple domains for measurement, a multitude of potential perspectives, and regulatory influences that emphasize measurement only of poor quality. Research efforts have yet to solve the issues of measurement; however, operators of long term care facilities must use the current state of the art in quality measurement as the basis for their quality improvement efforts. A project was commissioned by management of a large integrated delivery system with a robust network of LTC facilities who wished to implement a continuous quality improvement process on the basis of a measurement tool that provides a comprehensive resident-centered assessment of quality. The objectives of this project, therefore, were to identify domains of quality, to select and adapt validated instruments for measurement within each domain, to pilot test a data collection process, and to develop an operational quality profiling report format for LTC facilities.


METHODS
Using an expert panel and the LTC research literature, an operational measurement tool was developed, consisting of four domains of quality: organizational, clinical, environmental, and social.


CONCLUSIONS
A pilot study conducted in two nursing facilities demonstrated that the data collection process could be operationalized within tight resource and budgetary constraints. The development of an operational quality assessment tool enables management to take a consistent view of diverse institutions, focusing in detail on quality of care as it is perceived by residents. The tool allows evaluation of trends over time and comparison to external norms.
Moxey
Elizabeth D
ED
Office of Health Policy and Clinical Outcomes, Thomas Jefferson University, 1015 Walnut Street, Suite 115, Philadelphia, PA 19107-5099, USA. elizabeth.moxey@mail.tju.edu
O'Connor
John P
JP
White
Elizabeth
E
Turk
Barbara
B
Nash
David B
DB
D026683:Advisory Committees; D000368:Aged; D000369:Aged, 80 and over; D015510:Clinical Medicine / Q000592:standards; D019033:Delivery of Health Care, Integrated / Q000592:standards; D003697:Delphi Technique; D005260:Female; D005568:Forms and Records Control; D006272:Health Facility Environment / Q000592:standards; D006801:Humans; D007588:Job Satisfaction; D008134:Long-Term Care / Q000592:standards*; D008297:Male; D008875:Middle Aged; D009096:Multi-Institutional Systems / Q000592:standards*; D009937:Organizational Objectives; D017060:Patient Satisfaction; D010561:Personnel Staffing and Scheduling / Q000592:standards; D015143:Philadelphia; D010865:Pilot Projects; D011785:Quality Assurance, Health Care / Q000331:legislation & jurisprudence / Q000379:methods*; D019984:Quality Indicators, Health Care / Q000145:classification* / Q000458:organization & administration; D012866:Skilled Nursing Facilities / Q000331:legislation & jurisprudence / Q000592:standards*