Beyond CMS quality measure adjustments: identifying key resident and nursing home facility factors associated with quality measures.

OBJECTIVE This quality improvement (QI) project was initiated to understand what differentiates nursing homes (NHs) that perform well on publicly reported Centers for Medicare and Medicaid Services (CMS) Quality Measures (QMs). The intent was to assist NH staff to direct QI efforts to positively impact QM rates. A key step was to determine if any resident or facility characteristics might account for some of the variability in QMs of high-risk pressure ulcers (HRPrUs), low-risk incontinence (LRI), and Activities of Daily Living (ADL) decline, beyond those already adjusted for by CMS. DESIGN Observational Study. SETTING AND PARTICIPANTS The setting was 147 NHs across 12 northeast states owned by 1 for-profit, multifacility organization in 2006 and 2007. INTERVENTION None MEASUREMENTS Minimum Data Set (MDS), patient admission information, facility staffing metrics, and CMS QM data. RESULTS Relationships of facility and resident characteristics to QMs were evaluated using regression analyses performed separately for 2006 and 2007. Among factors found consistently to be significant (P < or = .05) for HRPrUs were percent admissions with pressure ulcers and percent residents with end-stage disease. For LRI, there was significant association with percent residents readmitted and percent incontinent of bladder on admission. ADL decline showed significant associations with licensed nurse turnover and facilities in specific states. CONCLUSION Several resident and facility factors were associated with QMs beyond those previously adjusted for by CMS. With introduction of MDS 3.0, we suggest further exploration of resident and facility factors identified in this study.