ENHANCED SET OF QUALITY MEASURES NOW AVAILABLE AT MEDICARE'S EASIER-TO-USE NURSING HOME COMPARE
The Centers for Medicare & Medicaid Services today unveiled an updated Nursing Home Compare website that includes enhanced quality measures and easier navigation at www.medicare.gov. The enhanced measures are part of CMS' ongoing commitment to use public reporting to improve the quality of care available in the nation's nursing homes.
"This website is a perfect example of our ability to empower Americans to improve their health through the use of the information technology," Health and Human Services Secretary Tommy G. Thompson said. "Not only have consumers become better informed, but nursing homes themselves have been taking steps to improve their quality of care. This is a win-win for everyone."
The improvements to Nursing Home Compare make it easier for consumers to compare quality, deficiency and staffing information about the nation's 17,000 Medicare and Medicaid-certified nursing homes. The fourteen enhanced quality measures build on the original ten measures and provide additional information to help consumers make informed decisions.
"We launched this national Initiative in November 2002 and are already beginning to see improvements in the quality of care available in many nursing homes because of the collaboration among CMS, the states, Quality Improvement Organizations, advocates and the nursing homes," said Dennis G. Smith, Acting CMS Administrator. "Not only are consumers asking more questions, but nursing homes are able to identify their own strengths and weaknesses."
The dynamic quality measures continue to be refined with recommendations from the National Quality Forum, a voluntary standard setting, consensus-building organization representing providers, consumers, purchasers and researchers. Working closely with CMS and the nation's nursing homes are the Quality Improvement Organizations, CMS contractors that provide quality improvement assistance to hospitals, physician offices, home health agencies and nursing homes.
Since the Initiative began in 2002:
- Approximately 2500 nursing homes are actively pursuing quality improvement efforts with the help of their state QIO.
- More than 99.5 percent of the nation's 17,000 nursing homes have been contacted by quality improvement organizations in their state about the Nursing Home Quality Initiative, the quality measures, and how to become involved in quality improvement efforts.
- More than 60 percent of nursing homes nationwide have attended at least one QIO-sponsored workshop on the quality measures and/or quality improvement techniques as applied in the nursing home environment.
- The Nursing Home Compare tool received 9.3 million page views in 2003 and was the most popular tool on www.medicare.gov. The 1-800-MEDICARE call centers received 5.9 million calls in 2003, a nine percent increase over 2002.
In addition, there have been improvements in outcomes in the following measures:
- The percent of residents with chronic pain dropped by more than 30 percent (from 10.7 percent to 7.3 percent) and has been seen in every state. Nationally, the chronic pain measure improved each quarter since the initial rollout in November 2002.
- The percent of residents who were physically restrained declined by 15 percent (from 9.7 percent to 8.2 percent) nationally and has been seen in 92 percent of states. Nationally, the daily physical restraint measure has improved each quarter since the initial rollout in November 2002.
- The percent of short stay residents who experienced pain decreased nationally by 11 percent in one year (from 25.4 percent to 22.6 percent).
The Pressure Ulcer measure has not changed significantly over the past 12 months, (from 8.5 percent to 8.8 percent). However, the trend is toward worse performance on this measure in 82 percent of states, so it is a widespread finding. This change may or may not mean that clinical care has deteriorated. CMS and the QIOs are working closely with nursing homes to monitor this, and assure that care does indeed improve. As clinicians focus on a given kind of care (such as skin care) they also become more accurate in measurement.
"Not only does collecting this data show where improvements are made, but where there has been a decline in quality, which is an important role for the Nursing Home Quality Initiative," said Smith. "The pressure ulcer measure results are an interesting example of the interaction between measurement and clinical improvement, and we will work with nursing homes to be sure that both improve over time."
The enhanced chronic care measures now available at Nursing Home Compare are:
- Percent of residents whose need for help with daily activities has increased
- Percent of residents who have moderate to severe pain
- Percent of residents who were physically restrained
- Percent of residents who spent most of their time in bed or in a chair
- Percent of residents whose ability to move about in and around their room got worse
- Percent of residents with a urinary tract infection
- Percent of residents who have become more depressed or anxious
- Percent of high risk residents who have pressure sores
- Percent of low risk residents who have pressure sores
- Percent of low risk residents who lose control of their bowels or bladder
- Percent of residents who have/had a catheter inserted and left in their bladder
The enhanced post-acute care measures that will be posted are:
- Percent of short stay residents who had moderate to severe pain
- Percent of short stay residents with delirium
- Percent of short stay residents with pressure sores
The National Nursing Home Quality Initiative is a four-pronged effort, consisting of:
- CMS' continuing regulatory and enforcement efforts conducted by state survey agencies;
- improved consumer information on the quality of care in nursing homes;
- continual community-based, quality improvement programs offered to nursing homes by Medicare's Quality Improvement Organizations (QIOs); and
- collaboration and partnership to leverage knowledge and resources.
"We are all in this together -- residents, families, agencies, nurses, employees and advocates," said Smith. "By enhancing the quality measures, we can further improve our ability to provide valuable information to consumers, in turn helping them make more informed decisions when choosing nursing home care."
More information on the enhanced measures, including a table that provides a comparison between the initial quality measures and the enhanced set of quality measures, can be accessed at the CMS web site, www.cms.hhs.gov. Comparative nursing home information can be found at www.Medicare.gov and clicking on the "Nursing Home Compare" link, or by calling 1-800-MEDICARE (800-633-4227).