Measuring the quality of care provided to dually enrolled Medicare and Medicaid beneficiaries living in nursing homes.
OBJECTIVE
To adapt the Assessing Care of Vulnerable Elders project nursing home (NH) specific quality indicators (QIs), for use with routinely collected data, and to evaluate which clinical conditions and types of care were inadequately measured using these data sources.


METHODS
Retrospective cohort study.


METHODS
Nursing homes.


METHODS
NH residents 66 years of age and older dually enrolled in Medicare and Medicaid in 19 California counties between 1999 and 2000.


METHODS
Identification of care inaccessible to measurement by Medicare and Medicaid claims linked to the Minimum Data Set (MDS). Assessment of care provided for measurable QIs by condition (eg, heart failure) and by intervention type (eg, medication use).


RESULTS
Only 50 of 283 QIs were captured using linked claims data. The 21,657 patients triggered 152,376 QIs (7.0 QIs/person). The overall QI pass rate (receipt of recommended care) for eligible participants was 76%. In this sample, QIs with the highest pass rates measured avoidance of adverse medications and appropriate medication use. Fewer than half of the QIs were passed for ischemic heart disease, stroke, and osteoporosis. The MDS permitted assessment of 8 QIs that focus on geriatric care. No measured QIs assessed history taking or nursing care.


CONCLUSIONS
The use of claims data linked to MDS to measure the quality of care process measures is feasible for NH populations, but would be more valuable if additional data elements focused on geriatric and residential care. QIs that could be applied to patients in this study suggested areas of care needing improvement.
Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, 911 Broxton Avenue, Los Angeles, CA 90095-1736, USA. dzingmond@mednet.ucla.edu
David S
DS
Zingmond
Debra
D
Saliba
Kathleen H
KH
Wilber
Catherine H
CH
MacLean
Neil S
NS
Wenger
D000368:Aged; D000369:Aged, 80 and over; D002140:California; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid; D006278:Medicare; D009735:Nursing Homes / Q000592:standards*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology