Page 561 Cite

Suggested Citation:"Appendix C: Recommendations by Area of Measurement and by Area of Research." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.

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Appendix C

Recommendations by Area of Measurement and by Area of Research

Table C-1 provides an overview of the areas of measurement included among the committee’s recommendations. For some topics, measures exist and can be added to Care Compare immediately, while other areas are in need of development and testing of measures. Table C-2 provides an overview of the priority areas for research (including demonstration projects) and data collection identified by the committee as part of their recommendations. See the committee’s full recommendations in Chapter 10.

Page 562 Cite

Suggested Citation:"Appendix C: Recommendations by Area of Measurement and by Area of Research." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.

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TABLE C-1 Recommended Quality Measures for Reporting or Development and Testing

DOMAIN	Measure	Recommendation
Staffing	Staff satisfaction and well-being Structural measures (e.g., routine training in infection prevention, staff employment arrangements [e.g., full-time, part-time, contract and agency staff])	6C
Financing and Ownership	Structural measures (e.g., financial performance)	6C
Financing and Ownership	Performance of facilities with common ownership	6B
Care Delivery	Degree of implementation and success of care plan	1A
	Consumer Assessment of Healthcare Providers and Systems (CAHPS^®) survey of resident/family experience	6A
	Resident preferences	6B
	Palliative and end-of-life care Receipt of care that aligns with resident’s goals, and the attainment of those goals Implementation of the resident’s care plan Psychosocial and behavioral health	6C
Quality Assurance	Oversight performance metrics of survey agencies	5A
	Effectiveness of long-term care ombudsman programs	5C
Equity Health Information Technology (HIT)	Risk adjustment	6B
	Disparities in nursing home care	6D
	HIT adoption and interoperability	6C, 7B
	Staff and resident/family perceptions of HIT usability	7B
Emergency Preparedness and Infection Control	Documentation of emergency plans Conduct of emergency drills Staff awareness of emergency management plans	1D
Emergency Preparedness and Infection Control	Structural measures (e.g., emergency preparedness, training in infection prevention, emergency response management, percentage of single occupancy rooms)	6C

Page 563 Cite

Suggested Citation:"Appendix C: Recommendations by Area of Measurement and by Area of Research." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.

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TABLE C-2 Recommended Priority Areas for Research and Data Collection

DOMAIN	Area of Research and Data Collection	Recommendation
Quality Measurement	Development and testing of various quality measures	See Table C-1
Staffing	Minimum and optimum staffing standards for direct care providers	2C
	Baseline demographic information of medical directors, administrators, and directors of nursing	2H
	Expertise and staffing patterns of medical directors, advanced practice registered nurses, social workers, physicians, and physician assistants	2H
	Numbers and staffing patterns for all contract and agency staff	2H
	Systemic barriers and opportunities to improve recruitment, retention, training and advancement of all nursing home workers (particularly certified nursing assistants [CNAs])	2I
Financing and Ownership	Facility-level data on the finances, operations, and ownership of all nursing homes	3A
	Quality of care across facilities with common ownership or management company	3B
	Impact of real estate ownership models and related-party transactions on quality of care	3B
	Design of a federal long-term care benefit and subsequent state demonstration programs	4A
	Alternative payment models for long-stay residents	4E
Care Delivery	Models of care delivery for short-stay and long-stay residents, reduction of care disparities, strengthening connections to community, and innovations in all aspects of care.	1B
Care Delivery	Models of care delivery that take advantage of the role of the CNA as a member of the interdisciplinary team	2E

Page 564 Cite

Suggested Citation:"Appendix C: Recommendations by Area of Measurement and by Area of Research." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.

×

Quality Assurance	Oversight performance metrics	5A
	Long-term reforms such as enhanced data monitoring to triage inspections, increased oversight of poorly performing facilities, modified oversight of high-performing facilities, and greater use of a variety of enforcement remedies	5B
	Effectiveness of long-term care ombudsman programs	5C
Equity	Gender, ethnicity, and race-related outcomes of job quality indicators (e.g., hiring, turnover, job satisfaction)	2I
Equity	Nursing home disparities and the development of policies and culturally tailored interventions	6D
Health Information Technology (HIT)	Levels of HIT adoption and interoperability	7B
	Nursing home staff, resident, and family perceptions of HIT usability	7B, 7D
	Use of HIT to improve resident outcomes	7D
	Disparities in HIT adoption and use	7D
	Innovative HIT applications for resident care	1B, 7D

The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff (2022)

Chapter: Appendix C: Recommendations by Area of Measurement and by Area of Research

Appendix C

Recommendations by Area of Measurement and by Area of Research

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The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff (2022)

Chapter: Appendix C: Recommendations by Area of Measurement and by Area of Research

Appendix C Recommendations by Area of Measurement and by Area of Research

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Appendix C

Recommendations by Area of Measurement and by Area of Research