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)居民接受长期护理的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)推出了一份带有NH质量措施(QMS)的国家报告--“疗养院比较”网站，公布了从最低数据集(MDS)得出的关键质量结果衡量标准。预计NH质量报告将使消费者能够根据质量选择NH服务，并通过市场竞争刺激质量改进。鉴于其潜在影响，至关重要的是，成绩单质量衡量标准必须准确区分质量良好的房屋和质量较差的房屋。由于健康结果由护理质量以及居民的脆弱程度和合并症决定，因此有必要根据不同设施之间的病例组合差异进行调整，然后再比较它们的结果。然而，在线的NH QMS不采取或仅采取最小步骤来调整居民的特征。这项研究建议检验国家“疗养院比较”质量管理体系与基于相同结果但包含广泛风险调整的质量措施之间的相关性。为了符合R03的范围，这项研究将只关注目前报道的慢性护理指标中的一项-养老院中对日常生活活动(ADL)帮助需求增加的居民的百分比。在该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RO1的基础。这项拟议研究的具体目的是检验一种假设，即基于已发表的ADL状态的“疗养院比较”质量测量的疗养院质量排名和离群点状态不同于基于综合风险调整的相同结果的排名和离群点状态。这项研究将使用国家MDS数据，基于最先进的统计回归方法，制定全面的风险调整措施，并论证使用这些措施进行“养老院比较”的可行性和意义。拟议研究的结果将有助于努力制定改进的、有效的和可信的、基于风险调整的、以结果为基础的质量措施，这些措施很可能在公共成绩单中有效。

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.