Feasibility of quality indicators for the management of geriatric syndromes in nursing home residents.
OBJECTIVE
The assessment and management of dementia, falls and mobility disorders, malnutrition, end-of-life issues, pressure ulcers, and urinary incontinence have been identified as important quality improvement targets for vulnerable elders residing in nursing homes. This study aimed to identify valid and feasible measures of specific care processes associated with improved outcomes for these conditions.


METHODS
Nine experts in nursing home (NH) care participated in a modified Delphi process to evaluate potential quality indicators (QIs) for care in NHs. Panelists met and discussed potential indicators before completing confidential ballots rating validity (process associated with improved outcomes), feasibility of measurement (with charts or interviews), feasibility of implementation (given staffing resources in average community NHs), and importance (expected benefit and prevalence in NHs). The NH panel's median votes were used to identify a final set of QIs that were subsequently reviewed by a clinical oversight committee.


RESULTS
Sixty-eight geriatric syndrome QIs were identified as valid and important in NH populations. Panelists assessed 12 (18%) of these QIs as having questionable feasibility to implement in average community nursing homes trying to provide quality care. Nine (13%) would not be included in systems assessing quality of care for persons with advanced dementia or poor prognosis.


CONCLUSIONS
Steps of care critical to the assessment and management of geriatric syndromes in NHs were identified. Feasibility is an important issue for a significant number of these, indicating that much remains to be done to design systems that efficiently and reliably implement these care processes.
Saliba
Debra
D
VA HSR&D Center for the Study of Healthcare Provider Behavior, VA Greater Los Angeles, CA, USA. saliba@rand.org
Solomon
David
D
Rubenstein
Laurence
L
Young
Roy
R
Schnelle
John
J
Roth
Carol
C
Wenger
Neil
N
D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D003697:Delphi Technique; D003704:Dementia / Q000175:diagnosis / Q000628:therapy; D005240:Feasibility Studies; D016330:Frail Elderly; D006707:Homes for the Aged / Q000592:standards*; D006801:Humans; D044342:Malnutrition / Q000175:diagnosis / Q000628:therapy; D051346:Mobility Limitation; D009735:Nursing Homes / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D003668:Pressure Ulcer / Q000175:diagnosis / Q000628:therapy; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results; D014481:United States; D014549:Urinary Incontinence / Q000175:diagnosis / Q000628:therapy