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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

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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.

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.
×

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
  • 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
  • Structural measures (e.g., emergency preparedness, training in infection prevention, emergency response management, percentage of single occupancy rooms)
6C
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.
×

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
  • Models of care delivery that take advantage of the role of the CNA as a member of the interdisciplinary team
2E
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
  • 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
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.
×
Page561
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.
×
Page562
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.
×
Page563
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.
×
Page564
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Nursing homes play a unique dual role in the long-term care continuum, serving as a place where people receive needed health care and a place they call home. Ineffective responses to the complex challenges of nursing home care have resulted in a system that often fails to ensure the well-being and safety of nursing home residents. The devastating impact of the COVID-19 pandemic on nursing home residents and staff has renewed attention to the long-standing weaknesses that impede the provision of high-quality nursing home care.

With support from a coalition of sponsors, the National Academies of Sciences, Engineering, and Medicine formed the Committee on the Quality of Care in Nursing Homes to examine how the United States delivers, finances, regulates, and measures the quality of nursing home care. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff identifies seven broad goals and supporting recommendations which provide the overarching framework for a comprehensive approach to improving the quality of care in nursing homes.

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