RAND Corporation, Santa Monica, California, USA.
RAND Corporation, Pittsburgh, Pennsylvania, USA.
J Am Geriatr Soc. 2020 Sep;68(9):1979-1987. doi: 10.1111/jgs.16466. Epub 2020 May 7.
The Centers for Medicare & Medicaid Services (CMS) Nursing Home Quality Initiative aims to improve quality through performance measurement. We describe quality improvement (QI) changes that skilled nursing facilities (SNFs) reported making in response to CMS performance measurements and whether reported QI changes were associated with better performance on CMS performance measures.
Nationally representative survey.
A total of 15,475 SNFs that reported quality performance on Nursing Home Compare in 2016.
A total of 1,182 SNFs (58% of random sample of 2,045 SNFs).
Adoption of 22 possible QI changes, grouped into seven categories (organizational culture, health information technology, care process redesign, provider incentives, changes to staffing responsibilities, performance monitoring, and measure-specific QI initiatives and technical assistance); performance on the CMS Nursing Home Compare Five-Star Quality Rating System's quality measure rating.
SNFs reported making an average of 13 QI changes (interquartile range = 11-16 changes). SNFs mostly commonly reported becoming a learning organization (87%) and providing training to staff on QI strategies (87%). After controlling for patient and facility characteristics, larger SNFs were more likely to obtain assistance on measure reporting from QI organizations and use provider champions than smaller SNFs by 14 and 11 percentage points, respectively. Rural SNFs and SNFs with higher proportions of disabled, black, or Hispanic residents adopted QI changes at similar rates as other SNFs. Of the 22 QI changes, 20 were considered at least somewhat helpful by more than 80% of adopting SNFs. Implementation of all 22 QI changes (vs no changes) was associated with a .48-star higher quality measure rating (95% confidence interval = .003-.98 stars; P = .05).
In response to CMS measurement programs, SNFs reported making substantial QI investments that were associated with better performance on CMS quality measures. To guide future SNF investments in QI, work is needed to identify the QI changes that yield the greatest performance improvements.
医疗保险和医疗补助服务中心（CMS）的疗养院质量倡议旨在通过绩效衡量来提高质量。我们描述了熟练护理设施（SNF）为响应 CMS 绩效衡量标准而做出的质量改进（QI）变化，以及报告的 QI 变化是否与 CMS 绩效衡量标准上的更好表现相关。
全国代表性调查。
总共 15475 家在 2016 年在疗养院比较中报告质量表现的 SNF。
总共 1182 家 SNF（2045 家 SNF 随机样本的 58%）。
采用 22 种可能的 QI 变化，分为七个类别（组织文化、健康信息技术、护理流程重新设计、提供者激励、人员配备职责变化、绩效监测以及特定于措施的 QI 举措和技术援助）；CMS 疗养院比较五星级质量评级系统的质量衡量评级上的表现。
SNF 报告平均实施了 13 项 QI 变化（四分位距 = 11-16 项变化）。SNF 最常见的报告是成为一个学习型组织（87%）并为员工提供关于 QI 策略的培训（87%）。在控制了患者和设施特征后，较大的 SNF 比较小的 SNF 更有可能分别获得 14 个和 11 个百分点的组织在报告措施方面的帮助和使用提供者冠军。农村 SNF 和残疾、黑人或西班牙裔居民比例较高的 SNF 与其他 SNF 一样，采用 QI 变化的速度相似。在 22 项 QI 变化中，有 20 项被超过 80%的采用 SNF 认为至少在某种程度上有所帮助。实施所有 22 项 QI 变化（与没有变化相比）与质量衡量评级提高.48 星（95%置信区间=.003-.98 星；P =.05）相关。
为了响应 CMS 测量计划，SNF 报告了大量的 QI 投资，这些投资与 CMS 质量衡量标准上的更好表现相关。为了指导未来 SNF 在 QI 方面的投资，需要努力确定能带来最大绩效提升的 QI 变化。
