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Table 1 Description of included studies

From: Evidence for publicly reported quality indicators in residential long-term care: a systematic review

Author (year)

Country

Aim

Study population (sample size)

Evaluated QI(s)

Methods and measurements

Bates-Jensen et al. (2003) [19]

U.S.

To determine whether nursing homes that score better on pressure ulcer prevalence MDS QI provide different pressure ulcer care.

329 residents at risk for pressure ulcer development in 16 nursing homes

Pressure ulcers

Sixteen QIs regarding pressure ulcer care, nutrition and incontinence management were scored using medical record data, direct human observation, interviews, and data from wireless thigh movement monitors.

Berg et al., (2002) [20]

U.S.

To summarize work done to identify and evaluate QIs for LTC settings.

MDS assessments from 1995 to 1997 from all nursing facilities in 5 states

143 QIs

Review of existing QIs, preliminary analyses that examined the incidence and prevalence of selected QIs in nursing facilities and the stability of the QI rates over time.

Bours et al. (1999) [21]

Netherlands

To describe the development of a national registration form to measure the prevalence of pressure ulcers.

34 experts in Delphi panel;

1 hospital, 1 nursing home and 1 home health care agency

Pressure ulcers

Literature review and Delphi panel, a pilot study with interrater reliability and feasibility assessment

Cadogan et al. (2004) [22]

U.S.

To compare pain-related care processes between nursing homes that scored high and low on the pain prevalence MDS QI

255 residents in 16 nursing homes (8 with low and 8 with high pain prevalence)

Pain

Care processes related to pain assessment, documentation, and treatment were independently evaluated by trained research staff using standardized resident interview and medical record review protocols.

Estabrooks et al. 2013 [23]

Canada

To identify RAI-MDS 2.0 QIs believed to be the most sensitive to clinical practice.

2 experts on QI and 16 informants (physicians, nurses and decision/ policy-makers)

35 MDS 2.0. QIs

Thirteen QIs chosen by the experts were rated individually by the informants for

overall “practice sensitivity”. The informants were also asked to identify the domain to which the QI was most sensitive (nursing care, physician care, or policy maker).

Hill-Westmoreland & Gruber-Baldini, 2005 [24]

U.S.

To assess the agreement between falls as recorded in the MDS and fall events abstracted from chart documentation.

462 residents in 56 nursing homes

Falls

Falls were abstracted from resident charts and compared with MDS falls variables: fell in the past 30 days and fell in the past 180 days.

Jones et al., 2010 [25]

U.S.

To describe a method for adjustment of nursing home QIs defined using the MDS.

5738 residents in 209 nursing homes; MDS data from 3294 U.S. facilities and 92 Canadian facilities.

79 MDS QIs

Development of new risk adjustment, assessment of validity and stability of QIs over time.

Karon et al., 1999 [26]

U.S.

To examine the stability of MDS QIs over each of two 3-month periods and one 6-month periods.

512 nursing facilities

30 MDS QIs

QI stability was assessed using corelations or Cohen’s Kappa. The variables included: proportion of residents in the facility with the QI condition; the facility’s percentile rank in its state; and a variable indicating whether the facility’s rank exceeded the 90th percentile in its state.

Mintz et al., 2021 [35]

U.S.

To validate the MDS v3.0 items on falls and injuries with chart review.

251 residents in 2 nursing homes

Falls with major injury

Fall and injury agreement between the MDS and chart review was assessed with Cohen’s Kappa test. Sensitivity, specificity and positive predictive value were calculated.

Mor et al., 2003 [27]

Morris et al., 2003 [39]

U.S.

To assess inter-rater reliability of MDS assessments which generate the data used for publicly reported QIs.

To report on validation of long-term and post-acute care QIs.

5758 residents in 209 nursing facilities in 6 states

22 MDS QIs

45 MDS QIs

Resident assessments by facility nurses and research nurses were compared using Kappa statistics.

Phillips et al., 2007 [36]

U.S.

To assess the impact of facility and resident characteristics on ADL change.

36′584 residents in 1334 nursing homes

Change in ADL function

Multivariate models estimated at the individual level.

Rantz et al., 1997 [29]

U.S.

To verify the accuracy of QIs derived from MDS data

10 nursing homes

14 QIs

Comparison of facilities performing well with those performing poor on QIs.

Rantz et al., 2004 [28]

U.S.

To examine cost, staffing, and quality of care information from the MDS and Medicaid cost report.

92 nursing homes

23 MDS QIs

Facilities were grouped based on how well they performed on the MDS QIs into good, average and poor. Stability of facility performance and sensitivity of QIs to discriminate between groups was analysed.

Sanghavi et al., 2020 [37]

U.S.

To assess the accuracy of nursing home self-report of major injury falls on the MDS.

MDS assessments and Medicare claims data 2011–2015

Falls with major injury

The proportion of claims-identified falls reported for each fall-related MDS item and the correlation between fall rates based on claims vs the MDS was calculated.

Schnelle et al., 2004 [30]

U.S.

To investigate whether the use of restraint differs in nursing homes that score in the upper and lower quartiles on the MDS prevalence of restraint QI.

413 residents

in 14 nursing homes

Restraint

Eight care processes related to the management of restraints, gait and balance problems were defined and operationalized into clinical indicators. Research staff conducted direct observations to determine the prevalence of restraining devices and identify resident and staff behaviours that may be affected by restraint use.

Schnelle et al., 2003 [31]

U.S.

To determine if nursing homes that score in the lower 25th percentile versus the upper 75th percentile on MDS incontinence QIs provide different incontinence care processes.

347 long-term residents in 14 skilled nursing facilities for the MDS “prevalence of incontinence” indicator and 432 residents in 16 skilled nursing facilities for the MDS “prevalence of incontinence without a toileting plan” indicator.

Incontinence

Nine care processes related to incontinence were defined and operationalized into clinical indicators. Research staff assessed implementation of each care process on 3 consecutive days. The assessment included resident interviews, physical performance evaluations, and chart abstraction using standardized protocols

Simmons et al., 2003 [34]

U.S.

To determine whether nursing homes that score differently on prevalence of weight loss, according to MDS QI,

also provide different processes of care related to weight loss.

400 long-term residents in 16 nursing homes

Weight loss

Sixteen care processes related to weight loss were defined and operationalized into clinical indicators. Research staff conducted measurement of nursing home staff implementation of each care process during assessments on three consecutive days, which included direct observations during meals, resident interviews, and medical record abstraction using standardized protocols.

Stevenson et al., 2004 [32]

U.S.

To determine the validity of the MDS to detect cases of urinary tract infection (UTI) that meet specific evidence-based criteria.

16 nursing homes

Urinary tract infection

Data from prospective surveillance of all types of infection, including UTI, and data on clinical manifestation, microbiology, and treatment were compared with MDS data on identification of UTI.

Wu et al., 2005 [33]

U.S.

To examine facility variation in data quality of the level of pain documented in the MDS as a function of level of hospice enrolment in nursing homes.

3469 nonhospice residents from 178 nursing homes

Pain

Study nurses’ and nursing home staff’s pain rating was compared across nursing homes with high, medium, or low hospice use. Multilevel models were built to assess the effect of nursing home hospice use levels on the occurrence of false positive and false negative errors in nursing home-rated “severe pain”.

Wu et al., 2009 [38]

U.S.

To examine the association between measurement errors in 8 MDS-derived measurement scales and 1) the characteristics of residents and nursing homes, 2) the MDS-derived QIs.

5174 pairs of MDS

assessments from 206 nursing homes

Pressure ulcers

Cognitive function

Incontinence

Restraints

Pain

ADL

Multivariate multilevel models were used to identify nursing home and resident characteristics associated with the data quality of MDS QIs. Coding differences between nursing home staff and study nurses served as outcomes. The pattern between the state averages of QIs and predicted averages of measurement bias was investigated.

Zimmerman et al., 1995 [6]

Zimmerman, 2003 [8]

U.S.

To report on the development and testing of QIs from RAI-MDS data.

 

31 of initial 175 QIs were pilot-tested, and 24 were included in a final set.

Clinical review, pilot testing of accuracy, feasibility and predictive power, description of risk adjustment.

  1. Abbreviations: ADL Activities of Daily Living, MDS Minimum Data Set, QI Quality indicator, RAI Resident Assessment Instrument, U.S. United States, UTI Urinary tract infection