Developing a method of assessing quality of care in nursing homes, using key indicators and population norms

This article illustrates how population norms on key indicators of quality can be used to assess quality of care in nursing homes. Five key indicators of quality were chosen from a Patient Care and Services Survey carried out by the Rhode Island State Department of Health: prevalence of contractures, in-house-acquired decubiti, use of restraints, lack of participation in an activities program, and nasogastric tube feeds. The population prevalence of these indicators was adjusted according to the case mix and size of each nursing home. A measure of quality suggested was the difference between the case-mix-adjusted prevalence and the prevalence observed by state surveyors. It was concluded that although the system is still in the exploratory stages, it has the potential to supplement the clinical judgment of nursing home surveyors with a more objective method of assessing compliance with quality of care standards.