Applying performance measures to long-term care.

Abstract

BACKGROUND: Nine nursing facilities in Mississippi participated in the American Health Care Association's Quality Indicator Index and Education (QUIIX-Ed) project to apply quantitative performance measurements to continuous quality improvement in long-term care. Begun in May 1994, with the first collection of performance measurement data in March 1995, the project used 15 measures of clinical care based on standardized assessments of resident conditions. METHODOLOGY: QUIIX-Ed assessed the impact of quality indicator information in nursing facilities based on Minimum Data Set resident assessments. Comparison reports allow each facility to profile its performance against that of other providers in the project. The project does not standardize the quality improvement process: the focus is on the incorporation of information into existing nursing care and quality improvement practices. OPERATIONAL ISSUES: Each month the facilities updated their quality indicator scores and exported those scores to a central database that aggregated scores to generate benchmarking statistics for each facility, including project medians, percentiles, and facility performance rankings. EXAMPLES: Two case studies on bedfast residents and restraint use illustrate the process of examining care issues identified by quality indicators, developing appropriate interventions, and evaluating the efficacy of the intervention. DISCUSSION: The limited intervention of introducing quantitative care measurements had a significant impact on resident outcomes and the nursing process. These measurements are readily incorporated into existing nursing practices and facility improvement efforts, regardless of the extent to which the quality improvement process has been developed.