Back to Annual Meeting

Back to Annual Meeting

APHA Scientific Session and Event Listing

Linda W. Tsan, MD, Chester Davis, ScD, and John R. Pierce, MD. Office of Medical Inspector (10MI), Department of Veterans Affairs, 810 Vermont A venue, NW, Washington, DC 20420, 202-501-0334, linda.tsan@va.gov

The Veterans Health Administration of the Department of Veterans Affairs (VA) is the largest single provider of healthcare in the US, operating 157 hospitals and 134 nursing home care units (NHCUs) with approximately 14,000 nursing home beds throughout the country. As a part of a quality improvement assessment, we analyzed the Minimum Data Set (MDS) Quality Indicators (QIs) from 134 VA NHCUs with over 15,000 long-stay (more than 90 days) residents each year for fiscal years 2003, 2004 and 2005 (FY03-05). In addition, we assessed the complexity of services provided to the VA NHCU long-stay residents as determined by the MDS Case-Mix Index (CMI). We found that from FY03 to FY05 there was a 5.1% increase in CMI. However, the majority of the MDS QIs showed a favorable decrease in prevalence and incidence from FY03 to FY05 despite the CMI increase. In particular, there were 9 QIs which showed an improvement of more than 20%, i.e., QI#23 Prevalence of little or no activities,73%; QI#11 Prevalence of fecal impaction, 65%; QI#22 Prevalence of daily physical restraints, 61%; QI#9 Prevalence of bowel and bladder incontinence without toileting plan, 50%; QI#15 Prevalence of dehydration, 38%; QI#5 Prevalence of the symptoms of depression without antidepressant therapy, 26%; QI#16 Prevalence of bedfast residents, 23%; QI#4 Prevalence of symptoms of depression, 21%; and QI#24lr (low risk) Prevalence of low risk stage 1-4 pressure ulcers, 21%. In contrast, only 1 QI showed an increased incidence of more than 20%, i.e., QI#7 Incidence of cognitive impairment, 30%. These results suggest that while the needs of VA NHCU long-stay residents are growing more complex from FY03-05, the quality indicators have improved during the same period. We aim to share this annual national profile and facility-specific profiles with VA NHCUs and Veterans Integrated Service Networks. We believe that this information will help VA NHCUs to determine where emphasis needs to be placed to continue to improve long term care to veterans.

Learning Objectives: At the conclusion of this session, participants will be able to

• List the Minimum Data Set Quality Indicators for the nursing homes
• Describe the improvement of Quality Indicators at VA nursing homes from FY 2003 to 2005
• Develop a plan to measure nursing home quality of care using Quality Indicators

Keywords: Nursing Homes, Quality Improvement

Presenting author's disclosure statement:

Any relevant financial relationships? No