Developing quality indicators for in-patient post-acute care.

Area of Science:

• Gerontology
• Health Services Research
• Quality Improvement

Background:

• Development of integrated functional, clinical, and discharge post-acute care (PAC) quality indicators (QIs).
• Utilizes items from interRAI assessments, including MDS 3.0, for inpatient PAC settings.
• Focuses on skilled nursing facilities (SNFs) across the United States.

Purpose of the Study:

• To describe an integrated series of PAC QIs.
• To examine the distribution of these QIs in US SNFs.
• To develop a summary scale for PAC QIs.

Main Methods:

• Analysis of 2,380,213 patient assessments from US SNFs in 2012 (MDS 3.0 data).
• Defined QIs using MDS assessment items.
• Employed regression modeling to create a summary scale of seven candidate PAC QIs.

Main Results:

• Developed risk-adjusted PAC QIs measuring functional status, walking, clinical status, and discharge to community.
• Observed patient improvement from baseline, but with substantial inter-state variation in summary QI scores.
• The PAC QI Summary Scale demonstrated distributional properties across facilities.

Conclusions:

• The set of PAC QIs includes functional, discharge, and clinical measures, plus a summary scale.
• QIs are derivable from multiple interRAI assessment tools (MDS 2.0, interRAI-LTCF, MDS 3.0, interRAI-PAC-Rehab).
• These measures support national and international comparison of PAC practices and outcomes.