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.

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
  • 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
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
  • 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.
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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
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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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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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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Page 563
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.
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Next Chapter: Appendix D: Recommendations by Responsible Partners
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