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关注的问题。2002年11月，医疗保险和医疗补助服务中心（CMS）发布了一份关于养老质量衡量标准（QMs）的全国报告——“养老院比较”网站，该网站公布了从最小数据集（MDS）中得出的质量衡量标准的关键结果。NH质量报告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善。考虑到它的潜在影响，报告卡质量指标准确区分质量好与质量差的房屋是至关重要的。由于健康结果是由护理质量和居民体质和合并症共同决定的，因此在比较结果之前，有必要根据不同设施之间的病例组合变化进行调整。然而，在线NH QMs不采取或仅采取最小步骤来调整居民特征。本研究拟在相同结果的基础上检验全国“养老院比较”质量管理体系与质量措施之间的相关性，但纳入了广泛的风险调整。为了符合RO3的范围，本研究将只关注目前报道的一项慢性护理措施-疗养院中对日常生活活动（ADL）需求增加的居民的百分比。在这个项目中开发的方法和得到的经验教训将作为以后检查其他已发布的质量度量的RO1的基础。本研究的具体目的是检验基于已发表的“养老院比较”ADL状态质量度量的养老院质量排名和离群状态与基于综合风险调整的相同结果度量的排名和离群状态不同的假设。本研究将使用国家MDS数据，基于最先进的统计回归方法，开发综合风险调整措施，并证明在“养老院比较”中使用这些措施的可行性和研究意义。拟议研究的结果将有助于努力制订改进的、有效和可信的、经风险调整的、基于结果的质量衡量标准，这些标准可能在公开报告卡中有效。

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.