A Test of the Validity of the "Nursing Home Compare" Measure of Physical Function

描述（由申请人提供）：疗养院（NH）居民接受的长期护理质量仍然是一个持续的问题。2002年11月，医疗保险和医疗补助服务中心（CMS）发布了一份带有NH质量指标（QM）的国家报告-“护理之家比较”网站，该网站发布了来自最小数据集（MDS）的关键结果质量指标。NH质量报告预计将使消费者能够根据质量选择NH服务，并通过市场竞争促进质量改进。鉴于其潜在影响，报告卡质量指标准确区分质量好的房屋和质量差的房屋至关重要。由于健康的结果是由护理质量和居民的弱点和合并症，有必要调整的情况下，混合设施之间的变化，他们的结果进行比较之前。然而，在线NH QM不采取或仅采取最小步骤来调整居民特征。本研究旨在探讨全国“护理之家比较”品质管理模式与品质指标之间的相关性，并以相同的结果为基础，结合广泛的风险调整。为了符合RO 3的范围，本研究将仅关注目前报告的慢性病护理措施之一-养老院中需要日常生活活动（ADL）帮助的居民的百分比增加。在这个项目中开发的方法和吸取的经验教训将作为以后审查其他已公布的质量措施的RO 1的基础。拟议的研究的具体目的是检验这一假设，即养老院的质量排名和离群值状态的基础上公布的“养老院比较”ADL状态的质量措施是不同的排名和离群值状态的基础上的措施相同的结果与综合风险调整。本研究将使用全国MDS数据，基于最先进的统计回归方法，开发全面的风险调整措施，并证明使用这些措施的可行性，并检查“养老院比较”的含义。“拟议研究的结果将有助于制定改进的、有效的和可信的、基于风险调整的结果的质量衡量标准，这些标准可能在公共报告卡中有效。

DESCRIPTION (provided by applicant): Quality of long-term care received by nursing home (NH) residents remains a persistent concern. In November 2002, the Centers for Medicare and Medicaid Services (CMS) launched a national report with NH quality measures (QMs) -the "Nursing Home Compare" Web site, which publishes key outcomes measures of quality derived from the Minimum Data Set (MDS). The NH quality report is expected to empower consumers to choose NH services based on quality, and to stimulate quality improvement through market competition. Given its potential impact, it is critical that the report card quality measures accurately differentiate homes with good quality from those with poor quality. Since health outcomes are determined by both care quality and resident frailties and comorbidities, it is necessary to adjust for case mix variations between facilities before their outcomes are compared. The online NH QMs, however, take no or only minimal steps to adjust for resident characteristics. This study proposes to examine the correlations between the national "Nursing Home Compare" QMs and quality measures based on the same outcomes but incorporating extensive risk adjustment. To fit within the scope of an RO3, this study will focus on only one of the chronic care measures currently reported - percent of residents in a nursing home whose need for help with activities of daily life (ADL) has increased. The methods developed in this project and the lessons learned would serve as a basis for a later RO1 that would examine the other published quality measures. The specific aim of the proposed study is to test the hypothesis that nursing homes' quality rankings and outlier status based on the published "Nursing Home Compare" quality measure of ADL status are different from rankings and outlier status based on the measure of the same outcomes with comprehensive risk adjustment. This study will use the national MDS data to develop comprehensively risk-adjusted measures based on state-of-the-art statistical regression methods, and demonstrate the feasibility and examine the implications of using such measures for "Nursing Home Compare." Findings of the proposed study will contribute to efforts to develop improved, valid and credible risk-adjusted outcome-based measures of quality that are likely to be effective in public report cards.