The Quality Indicator Survey: background, implementation, and widespread change.

Area of Science:

• Healthcare policy and regulation
• Gerontology and long-term care
• Quality improvement in healthcare

Background:

• The Quality Indicator Survey (QIS) represents a significant regulatory overhaul for nursing homes, superseding the Omnibus Budget Reconciliation Act of 1987 (OBRA-87).
• Developed over a decade, QIS was initiated nationally by the Centers for Medicare and Medicaid Services (CMS) in 2007.
• The primary goals of QIS are to enhance survey consistency and create a more resident-centered approach, aligning with OBRA-87's objectives.

Purpose of the Study:

• To detail the policy background and evolution leading to the QIS.
• To summarize the methodology, implementation, and survey results of the QIS.
• To analyze the impact of QIS on nursing home deficiencies and regulatory practices.

Main Methods:

• Review of policy documents and firsthand accounts from QIS development and training leaders.
• Analysis of publicly available Nursing Home Compare data from 2004 to 2010 to track changes in survey findings.
• Examination of QIS implementation across 19 states between 2007 and 2010.

Main Results:

• By 2010, nearly 20% of U.S. nursing homes were surveyed using QIS.
• QIS surveys initially identified more deficiencies on average compared to traditional methods.
• QIS implementation led to greater uniformity in deficiency rates across states, with areas previously below average seeing increases and vice versa.
• Specific QIS questioning correlated with increased deficiencies in resident choice, dignity, dental care, and nurse staffing.

Conclusions:

• CMS's QIS implementation is a pivotal advancement towards more resident-centered, comprehensive, and consistent nursing home oversight.
• The QIS necessitates significant adaptation from both regulatory bodies and nursing home providers.
• Adoption of new quality assessment and assurance norms is crucial for fostering a culture of change within U.S. nursing homes.