Challenges in measuring nursing home and home health quality: lessons from the First National Healthcare Quality Report.
BACKGROUND
The availability of patient assessment data collected by all Medicare- and Medicaid-certified nursing homes (NHs) (the Minimum Data Set [MDS]) and home health agencies (HHAs) (the Outcome and Assessment Information Set [OASIS]) provides an opportunity to measure quality of care in these settings.


OBJECTIVE
The objective of this study was to examine methodologic issues encountered as these datasets are used to report the nation's health care in the National Healthcare Quality Report (NHQR) at national and state levels.


RESULTS
Although the reliability of most data elements from MDS and OASIS are considered acceptable in research studies, mixed evidence exists for the reliability and validity of the quality measures themselves. Detection bias can affect the quality measures, particularly for pain and pressure ulcers. Although risk adjustment is used for all measures, effectiveness varies among measures and methods. Additional quality measures such as patient satisfaction, quality of life, and structural measures would be desirable but will require additional data collection efforts. Although the NH measures represent most NH residents, the HHA measures only apply to Medicare and Medicaid patients served by Medicare-certified agencies. Finally, the absence of clinical benchmarks limits the interpretation of the NHQR HHA and NH measures.


CONCLUSIONS
Further developmental work is needed to address many of these issues to improve the usefulness of these quality measures in future NHQR reports.
Sangl
Judith
J
Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, MD 20850, USA. jsangl@ahrq.gov
Saliba
Debra
D
Gifford
David R
DR
Hittle
David F
DF
D000203:Activities of Daily Living; D000328:Adult; D000847:Annual Reports as Topic; D005260:Female; D018574:Home Care Agencies; D006699:Home Care Services / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008484:Medicaid; D006278:Medicare; D009735:Nursing Homes / Q000592:standards*; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care; D018570:Risk Assessment; D014481:United States; D016270:United States Agency for Healthcare Research and Quality