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Setting thresholds for quality indicators derived from MDS data for nursing home quality improvement reports: An update |
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Determining meaningful thresholds to reinforce excellent performance and flag potential problem 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 if homes falsely assume they do not have care problems because they are "better than average." If the objective is to encourage higher levels of performance, it is imperative to set high, but attainable, standards for all to achieve. This article builds on the work of an earlier panel of experts who participated in an expert panel for threshold setting for quality indicators (QIs) derived from minimum data set (MDS) assessment data. It was necessary to conduct a new panel due to
the revisions of the MDS and the QIs derived from the MDS. Once again, a cross-section of 15 well-qualified clinical care personnel from nursing homes participated in an expert panel for threshold setting for the revised MDS Version 2.0 two-page quarterly and RUGS III quarterly instruments. Panel members met as a group for a day, individually determined lower (good) and upper (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 interpreting scores, we designed a feedback report, the "Show-me MDS Quality Indicator Report" so staff in nursing 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 has just been completed and now an electronic version of the "Show-me MDS Quality Indicator Report" using the thresholds set by this expert panel is available to all Missouri nursing homes.
Rantz, M.J., Petroski, G., Madsen, R., Mehr, D., Popejoy, L., Hick, L., Porter, R., Zwygart-Stauffacher, M. & Grando, V. (2000). Setting thresholds for quality indicators derived from MDS data for nursing home quality improvement reports: An update. Joint Commission Journal on Quality Improvement, 26(2): 101-110. |