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Amy B. Jessop, PhD, MPH, Jocelyn Andrel, MSPH, Naomi Hauser, RN, MPA, CLNC, and David Wenner, DO. Quality Insights of Pennsylvania, 585 E. Swedesford Rd, Suite 100, Wayne, PA 19087, 877-346-6180, ajessop@wvmi.org
Background: In 2002, the Centers for Medicare & Medicaid Services implemented a national Nursing Home Quality Initiative designed to improve quality of care and provide public access to MDS-based nursing home quality measures. Publication of the measures allows for regional, state, and individual nursing home level comparisons. Pennsylvania nursing homes consistently lead the nation in reported decline in activities of daily living (ADL) (PA 29%, National 15%) while other quality measures approximate the national averages. No reason is evident for the high-level ADL decline. This project examines nursing home characteristics to identify factors associated with ADL decline in Pennsylvania nursing homes. Methods: CMS reported quality measures for 2002 were merged with facility characteristic data derived from the 2002 Pennsylvania Department of Health’s Long-term Care Facility Questionnaire. Univariate and multivariate analysis was employed to identify factors associated with ADL decline. Results: Factors examined included type of ownership (for-profit, non-profit, government, chain), specialized services and agreements (Alzheimer’s units, continuing care, home health), patient mix (age, race, insurance), staffing levels (nursing, aides, therapeutic staff), location (urban, suburban, rural), and reimbursement rates (Medicare, Medicaid, private, VA, self-pay). Significant and non-significant associations are presented. The factors independently associated with ADL decline - continuing care agreements, staffing levels, and location - are presented and discussed in detail. Conclusions: Identification of facility-level factors provides a basis for development of facility and statewide initiatives designed to address ADL decline in nursing homes. This study also informs the next stage of research examining regulatory provisions and internal program practices.
Learning Objectives:
Keywords: Nursing Homes, Quality Improvement
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.