Pay-for-performance policy and data-driven decision making within nursing homes: a qualitative study.
BACKGROUND
Health systems globally and within the USA have introduced nursing home pay-for-performance (P4P) programmes in response to the need for improved nursing home quality. Central to the challenge of administering effective P4P is the availability of accurate, timely and clinically appropriate data for decision making. We aimed to explore ways in which data were collected, thought about and used as a result of participation in a P4P programme.


METHODS
Semistructured interviews were conducted with 232 nursing home employees from within 70 nursing homes that participated in P4P-sponsored quality improvement (QI) projects. Interview data were analysed to identify themes surrounding collecting, thinking about and using data for QI decision making.


RESULTS
The term 'data' appeared 247 times in the interviews, and over 92% of these instances (228/247) were spontaneous references by nursing home staff. Overall, 34% of respondents (79/232) referred directly to 'data' in their interviews. Nursing home leadership more frequently discussed data use than direct care staff. Emergent themes included using data to identify a QI problem, gathering data in new ways at the local level, and measuring outcomes in response to P4P participation. Alterations in data use as a result of policy change were theoretically consistent with the revised version of the Promoting Action on Research Implementation in Health Services framework, which posits that successful implementation is a function of evidence, context and facilitation.


CONCLUSIONS
Providing a reimbursement context that facilitates the collection and use of reliable local evidence may be an important consideration to others contemplating the adaptation of P4P policies.
School of Nursing, Purdue University, West Lafayette, Indiana, USA.
Kathleen
K
Abrahamson
Indiana University School of Medicine, Indianapolis, Indiana, USA.
Edward
E
Miech
School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA.
Heather Wood
HW
Davila
School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA.
Christine
C
Mueller
Minnesota Department of Human Services, Minneapolis, Minnesota, USA.
Valerie
V
Cooke
School of Nursing, Purdue University, West Lafayette, Indiana, USA.
Greg
G
Arling
D003657:Decision Making; D006707:Homes for the Aged / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007407:Interviews as Topic; D007857:Leadership; D009735:Nursing Homes / Q000458:organization & administration* / Q000592:standards; D017063:Outcome Assessment, Health Care; D057766:Policy; D036301:Qualitative Research; D058996:Quality Improvement / Q000458:organization & administration* / Q000592:standards; D012052:Reimbursement, Incentive / Q000458:organization & administration*
Nursing homes; Pay for performance; Quality improvement