Quality indicators for the management of medical conditions in nursing home residents.
OBJECTIVE
The purpose of this study was to develop a set of specific care processes associated with better outcomes for general medical conditions identified as quality improvement targets for institutionalized vulnerable elders.


METHODS
A national panel of nursing home experts used a modified-Delphi process to rate the validity (process linked to improved outcomes) and feasibility (of implementation and measurement) of candidate measures for depression, diabetes, hearing impairment, heart failure, hypertension, ischemic heart disease, osteoarthritis, osteoporosis, pneumonia, stroke, and vision impairment. Each quality indicator was written as an "if" statement, describing persons to whom the quality indicator applied followed by a "then" statement identifying the care process to be provided. A separate clinical committee reviewed the resulting set of indicators.


RESULTS
One hundred fourteen quality indicators were identified across the 11 medical conditions. The quality indicators capture a broad range of medical care addressing assessment, management, and follow up. Fifty-five indicators (48%) were identical to quality measures for community-dwelling vulnerable elders. A limited number were rated as questionably feasible to implement or measure (6 and 2, respectively). Thirty-eight (33%) would not be applied to measures of care quality for persons with advanced dementia or poor prognosis.


CONCLUSIONS
Explicit care processes linked to improved nursing home outcomes for general medical conditions can be identified. Most of these care processes can be measured by medical records or interview. Nursing home quality measures for medical conditions must account for exclusions related to poor prognosis and advanced dementia.
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
D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000628:therapy; D003697:Delphi Technique; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy; D005240:Feasibility Studies; D006707:Homes for the Aged / Q000592:standards*; D006801:Humans; D009735:Nursing Homes / Q000592:standards*; D010003:Osteoarthritis / Q000175:diagnosis / Q000628:therapy; D010024:Osteoporosis / Q000175:diagnosis / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000628:therapy; D012678:Sensation Disorders / Q000175:diagnosis / Q000628:therapy; D014481:United States