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Setting thresholds for MDS quality indicators for nursing home quality improvement reports |
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Determining meaningful thresholds to reinforce excellent performance and flag potential problems areas in nursing home care is critical for preparing reports for nursing homes to use in their quality improvement programs. Simply providing feedback by comparing an individual facility's performance to statewide averages, medians, or percentile ranking may actually adversely affect care because homes may interpret their performance as superior to others because they are "better than average" and falsely assume they do not have care problems in area where they actually do have problems that need attention. If the objective is to encourage higher levels of performance, it is imperative to place high, but attainable, standards for all to achieve. A cross-section of 13 well-qualified clinical care personnel from nursing homes participated in an expert panel for threshold setting for quality indicators (QIs) derived from the minimum data set (MDS) assessment data. Panel members met as a group for a day, individually determined good and poor threshold scores for each QI, reviewed statewide distributions of MDS QIs and completed a follow-up Delphi of the final results. With thresholds established for good and poor scores we are now able to report MDS QI scores so homes can easily see where they are performing well and where they need to concentrate quality improvement efforts. A statewide study testing different educational support methods for quality improvement using MDS QIs is underway at this time.
Key Words: nursing care, nursing homes, quality improvement, quality measurement Rantz, M.J., Petroski, G.F., Madsen, R.W., Scott, J., Mehr, D., Popejoy, L., Hicks, L., Porter, R., Zwygart-Stauffacher, M., & Grando, V. (1997). Setting thresholds for MDS quality indicators for nursing home quality improvement reports. Joint Commission Journal on Quality Improvement, 23(11), 602-611. |