Skilled Nursing and Post-Acute Care Has Improved in 9 of 10 Quality Areas, Government Data Shows

Oct 12, 2011, 11:00 ET from Alliance for Quality Nursing Home Care

Alliance and AHCA partner with leading quality experts to detail positive trends in nursing home quality and identify key areas of focus for future quality efforts

WASHINGTON, Oct. 12, 2011 /PRNewswire-USNewswire/ -- With a commitment to quality improvement and transparency, the nation's two leading long term and post-acute care organizations today released a comprehensive report of the quality of care in America's nursing and rehabilitation facilities.  Relying on government data and expert analyses from leading quality researchers, the report shows that America's nursing facilities are continuing to build upon quality improvements reported in previous years, including measurable improvements in nine out of 10 quality measures since 2009. Data suggest that these improvements positively impact the quality of care and quality of life of the 2.5 million Americans that require skilled nursing facility (SNF) care annually.

The Alliance for Quality Nursing Home Care and American Health Care Association have partnered for the third consecutive year to compile government-measured, publicly available quality data that illustrate positive trends in quality improvement.  Expert analyses from independent researchers examine the rehabilitation capabilities of SNFs, trends in skilled nursing care and the need for quality measures to effectively evaluate rehabilitation outcomes among an increasingly diverse patient population.  Expert report contributors also address approaches to improving care transitions and reducing hospital readmissions for Medicare beneficiaries.

The Alliance and AHCA present data generated from the Centers for Medicare and Medicaid Services (CMS), which illustrate positive trends in quality in a majority of quality measures and quality indicators.   In the past year, nursing facilities have improved in all short-stay measures, which include patient delirium, pain and pressure ulcers, and a vast majority of long-stay measures including measureable improvements in activities of daily living (ADL), high-risk pressure ulcers, resident mobility and pain.

Leading experts in quality and healthcare research contributing to this year's report include Andrew Kramer, MD of Providigm Health and Professor of Medicine at the University of Colorado; Mary D. Naylor, Ph.D., RN, FAAN, Katherine M. Abbott, Ph.D., MGS and Karen B. Hirschman, Ph.D., MSW of the University of Pennsylvania; Mary Jane Koren, MD, MPH with Advancing Excellence in America's Nursing Homes and the independent health care advisory firm Avalere Health.

"This report is one way we demonstrate our commitment to quality improvement and increased transparency in the facility assessment process. This report also calls attention to key issues that our provider community sees as priorities in ensuring we can continue to build upon the improvements we have made," said Mark Parkinson, President and CEO of AHCA. "In doing so, we are challenging ourselves – and our partners in government and within the healthcare community – to closely examine the current quality measurement system and determine how we can do better."  

"Throughout this year's report, there is a strong focus on rehabilitative care in SNFs and our expanded role as a provider of post-acute care services," stated Alan Rosenbloom, President of the Alliance. "In our long-standing commitment to quality measurement, we recognize that measurement metrics must evolve to reflect the care provided and the patients served in nursing facilities nationwide, which requires addressing existing deficiencies in the quality measurement process and developing measures that adequately evaluate our performance, particularly in the areas of post-acute and rehabilitative care."

As the largest provider of post-acute rehabilitative services in the healthcare continuum, nursing facilities have seen a dramatic shift in patients requiring short-term therapy services intended to restore function so that patients can ultimately return to an independent living situation.  Contributors to the report found that current quality measures more commonly reflect the traditional role of nursing homes and do not allow for proper measurement of rehabilitation services for short-stay Medicare patients, therefore substantial change is needed in the area of nursing facility quality measures.  Andrew Kramer, MD, writes, "post-acute care has gravitated to a system of multiple transfers to different levels of care.  With this evolution, it is critical that measures of rehabilitation quality follow patients across these transitions over fixed time intervals rather than during individual stays."

The report offers a variety of recommendations for improving quality measurement and care processes, including:

  • Developing and endorsing more measures related to the care provided to short-stay nursing patients, particularly measures that assess functional improvement.
  • Strengthening the risk adjustment methodologies currently applied to the nursing facility measurement set.
  • Designing new measures, or revising current measures, to be used across post-acute care settings.
  • A paradigm shift in post-acute rehabilitation performance measurement that includes patient-reported function following rehabilitation discharge as patient function continues to change.
  • Improved intervention processes for preventing readmission from nursing homes to the hospital for the more frail and complex patients discharged from SNFs.
  • Transitional care approaches, proven successful in improving care among similar populations, should be made accessible to nursing home residents to assure high value care for seniors and disabled patients in our society.
  • Continued involvement in national quality improvement initiatives among all nursing facilities, which will further advance the community's quality agenda.

The full 2011 Annual Quality report is available via an e-book at http://aqnhc.org/2011qualityreport.

SOURCE Alliance for Quality Nursing Home Care