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The quality of quality measurement in U.S. nursing homes
- Authors:
- MOR Vincent, et al
- Journal article citation:
- Gerontologist, 43(Special Issue II), April 2003, pp.37-46.
- Publisher:
- Oxford University Press
This article examines various technical challenges inherent in the design, implementation, and dissemination of health care quality performance measures. Using national and state-specific Minimum Data Set data from 1999, the authors examined sample size, measure stability, creation of ordinal ranks, and risk adjustment as applied to aggregated facility quality indicators. Nursing home Quality Indicators now in use are multidimensional and quarterly estimates of incidence-based measures can be relatively unstable, suggesting the need for some averaging of measures over time. Current public reports benchmarking nursing homes' performances may require additional technical modifications to avoid compromising the fairness of comparisons.
Benchmarking and quality in residential and nursing homes: lessons from the US
- Authors:
- MOR Vincent, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(3), March 2003, pp.258-266.
- Publisher:
- Wiley
Performance measurement and benchmarking are common concerns in the delivery of long term care. It is common to measure the performance of providers and to publicly report these data. This paper examines selected technical challenges facing those who design, implement and disseminate health care quality performance measures. The article reviews the application of measures of performance in the US nursing home sector. Using examples drawn from the skilled nursing home arena, problems ranging from data reliability and validity, the multi-dimensional nature of quality measures and selection bias as well as differential measurement abilities are discussed. Benchmarking of performance is an inherently complex issue. However, to ensure that such comparisons are both fair and valid requires measures to be more technically sophisticated and sensitive to real changes attributable to changes in care.
Impact of legislation on nursing home care in the United States: lessons for the United Kingdom
- Authors:
- HUGHES Carmel M., LAPANE Kate L., MOR Vincent
- Journal article citation:
- British Medical Journal, 16.10.99, 1999, pp.1060-1063.
- Publisher:
- British Medical Association
Despite the growing recognition that our ageing population represents a major challenge to the provision of health services, no major government policy initiative had focused on this topic until the recent establishment of a royal commission. In the United States, following legislation in 1987, psychotropic drugs were used less and a more structured approach to care planning was observed. In the United Kingdom, a combination of structured assessment and review of patients, concerted educational interventions, and greater multidisciplinary working may improve long term care.