Quality of Care Measures for Nursing Homes

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To improve the quality of care in nursing homes for the 1.4 million Americans who currently reside in facilities across the country, the National Quality Forum (NQF) has endorsed 21 measures to be used to care for both long-term residents and short-stay patients. The NQF endorsed measures will be used in the Centers for Medicare & Medicaid Services' Nursing Home Compare, an online database for consumers to compare the care provided in more than 17,000 nursing homes across the country.

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In 2004, NQF endorsed an initial set of measures for publicly reporting care in nursing homes. With the completion of the current project, the 17 measures that were previously endorsed will be retired and, in some instances, replaced by the newly endorsed measures. These measures were recently retired in the transition to CMS' updated data collection instrument, the Minimum Data Set 3.0 (MDS 3.0).

"Choosing where to go for long or short-term care in a nursing home is an incredibly important decision," said Janet Corrigan, NQF president and CEO. "Patients and their families need reliable information on the quality of care being provided in skilled nursing facilities, so they can make informed decisions about the place they will receive care daily. The quality data derived from these measures will provide essential information about infection rates, patient care experiences, and the general health of residents in nursing homes across the country."

The 21 NQF endorsed nursing home measures assess patient outcomes and the patient's own experience of care for both long-term residents and short-stay patients. The measures address falls, infections, pressure ulcers, and the general health of residents and patients.

Examples of endorsed measures include:

• Percentage of patients who received influenza and pneumococcal vaccinations.
• Percentage of residents with urinary tract infections.
• Percentage of residents who require increased help with activities of daily living.
• Patient experience of care surveys for both long-term residents and short-stay patients.

NQF's Steering Committee on Nursing Homes was co-chaired by David Gifford, MD, MPH, Director, Rhode Island Department of Health, and Christine Mueller, PhD, RN, FAAN, Associate Professor and Chair, University of Minnesota School of Nursing.

"These measures will help consumers better understand and compare quality of care when selecting nursing homes and will help them to monitor care once they or a family member is in a nursing home," said Dr. Gifford. "Nursing homes can also use these measures to benchmark how they are doing compared to others in addressing important nursing home quality of care issues."

NQF is a voluntary consensus standards-setting organization. Any party may request reconsideration of the 21 endorsed recommendations, in whole or in part, by notifying NQF in writing no later than April 1, 2011. (To access the appeals form, go to the Nursing Homes project page (www.qualityforum.org/Projects/Nursing_Homes.aspx), then go to the section on appeals and click on the link to the standard's directory.) For an appeal to be considered, the notification must include information clearly demonstrating the appellant has interests that are directly and materially affected by the NQF-endorsed recommendations and that the NQF decision has had (or will have) an adverse effect on those interests.

Endorsed Measures

• Physical therapy or nursing rehabilitation/restorative care for long-stay patients with new balance problem (RAND).
• Percent of residents experiencing one or more falls with major injury (long stay) (CMS).
• The percentage of residents on a scheduled pain medication regimen on admission who report a decrease in pain intensity or frequency (short stay) (CMS).
• Percent of residents who self-report moderate to severe pain (short stay) (CMS).
• Percent of residents who self-report moderate to severe pain (long stay) (CMS).
• Percent of residents with pressure ulcers that are new or worsened (short stay) (CMS).
• Percent of high-risk residents with pressure ulcers (long stay) (CMS).
• Percent of residents assessed and appropriately given the seasonal influenza vaccine during the flu season (short stay) (CMS).
• Percent of residents assessed and appropriately given the seasonal influenza vaccine (long stay) (CMS).
• Percent of residents assessed and appropriately given the pneumococcal vaccine (short stay) (CMS).
• Percent of residents assessed and appropriately given the pneumococcal vaccine (long stay) (CMS).
• Percent of residents with a urinary tract infection (long stay) (CMS).
• Percent of low-risk residents who lose control of their bowels or bladder (long stay) (CMS).
• Percent of residents who have/had a catheter inserted and left in their bladder (long stay) (CMS).
• Percent of residents who were physically restrained (long stay) (CMS).
• Percent of residents whose need for help with activities of daily living has increased (long stay) (CMS).
• Percent of residents who lose too much weight (long stay) (CMS).
• Percent of residents who have depressive symptoms (long stay) (CMS).
• Consumer Assessment of Health Providers and Systems (CAHPS®) Nursing Home Survey: Discharged Resident Instrument (ARHQ).
• Consumer Assessment of Health Providers and Systems (CAHPS®) Nursing Home Survey: Long-Stay Resident Instrument (ARHQ).
• Consumer Assessment of Health Providers and Systems (CAHPS®) Nursing Home Survey: Family Member Instrument (ARHQ).

The National Quality Forum (NQF) operates under a three-part mission to improve the quality of American healthcare by:

• Building consensus on national priorities and goals for performance improvement and working in partnership to achieve them.
• Endorsing national consensus standards for measuring and publicly reporting on performance.
• Promoting the attainment of national goals through education and outreach programs.

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