The Use of Standardized Indicators as Quality Improvement Tools: An Application in Pennsylvania Nursing Homes

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Abstract
The Institute of Medicine recommends the use of key quality indicators (resident outcomes that suggest the presence of good or bad care) as tools for inter- facility comparison of the quality of care provided in nursing homes. In the spirit of this recommendation, the Health Care Financing Administration released selected results from its Medicare and Medicaid An nual Certification Survey to guide consumers in pur chasing nursing home services. However, because this information is published without adjustment for res ident characteristics that can influence the outcomes of nursing home care, its utility for policy-makers or consumers interested in variation in nursing home quality is limited. This research study utilizes federal and state survey data to evaluate variations in mor tality, pressure ulcers, urethral catheterization, and physical restraint use in 438 Medicare-certified skilled nursing care facilities in Pennsylvania. A standardization function adjusting for resident char acteristics known to influence outcomes is developed and estimated by ordinary least squares regression. Results suggest considerable variation in rates for these indicators across Pennsylvania nursing home facilities. Alternative uses for risk-adjusted key qual ity indicators as tools for improving nursing home quality and assisting potential consumers of nursing home care in making better informed choices are considered.