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Challenges in Measuring Nursing Home and Home Health Quality: Lessons From the First National Healthcare Quality Report

Sangl, Judith ScD, MPH*; Saliba, Debra MD, MPH; Gifford, David R. MD, MPH; Hittle, David F. PhD§

Original Article
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Background: The availability of patient assessment data collected by all Medicare- and Medicaid-certified nursing homes (NHs) (the Minimum Data Set [MDS]) and home health agencies (HHAs) (the Outcome and Assessment Information Set [OASIS]) provides an opportunity to measure quality of care in these settings.

Objective: The objective of this study was to examine methodologic issues encountered as these datasets are used to report the nation's health care in the National Healthcare Quality Report (NHQR) at national and state levels.

Findings: Although the reliability of most data elements from MDS and OASIS are considered acceptable in research studies, mixed evidence exists for the reliability and validity of the quality measures themselves. Detection bias can affect the quality measures, particularly for pain and pressure ulcers. Although risk adjustment is used for all measures, effectiveness varies among measures and methods. Additional quality measures such as patient satisfaction, quality of life, and structural measures would be desirable but will require additional data collection efforts. Although the NH measures represent most NH residents, the HHA measures only apply to Medicare and Medicaid patients served by Medicare-certified agencies. Finally, the absence of clinical benchmarks limits the interpretation of the NHQR HHA and NH measures.

Conclusions: Further developmental work is needed to address many of these issues to improve the usefulness of these quality measures in future NHQR reports.

From *Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Maryland; †VA HSR&D, UCLA Department of Medicine, and RAND, Santa Monica, California; the ‡Center for Gerontology & Healthcare Research, Brown University Quality Partners of Rhode Island, Providence, Rhode Island; and the §Center for Health Services Research, Division of Health Care Policy and Research, University of Colorado Health Sciences Center, Aurora, Colorado.

Dr. Sangl was supported by AHRQ intramural funding. Dr. Saliba is supported by a VA HSR&D Career Development award #RCD 01-006. Dr. Hittle was supported by CMS Contract No. 500-00-0026.

Reprints: Judith Sangl, ScD, MPH, 540 Gaither Road, Rockville, MD 20850. E-mail: jsangl@ahrq.gov.

© 2005 Lippincott Williams & Wilkins, Inc.