South Dakota nursing homes will attempt to measure patient outcomes in a pilot project that coordinators hope will be a model for a quality-oriented evolution of federal certification rules.
The state this fall plans to apply for a five-year waiver from survey and certification requirements so South Dakota's 110 nursing homes can participate in the proj-ect, which will require facilities to transmit computerized patient data to the state every month.
The project, being coordinated by the American Health Care Association, a nursing home trade group, follows up on a nine-facility pilot program in Mississippi that used 15 clinical indicators. South Dakota will use 31 clinical indicators as well as consumer satisfaction surveys that will involve the families of nursing home residents.
Since April, South Dakota has been using nursing home clinical quality indicators in its surveys to check on compliance with federal nursing home standards. But the nursing homes can't always see that data.
Under the new project, however, nursing homes would always have access to their quality data, as well as data from the rest of the state, so they could continuously track their own performance compared with their own past performance and that of their peers.
"This is a step beyond what the new survey calls for," said Joan Bachman, administrator of the South Dakota office of healthcare facility licensure and certification.
Among the clinical indicators the nursing homes will use are occurrence of bedsores, use of psychotropic drugs or restraints, weight loss and urinary tract infections, Bachman said. She said state surveyors still will make scheduled visits.
The AHCA hopes to follow quickly with similar pilot programs in other states to demonstrate that the quality-oriented monitoring system "makes a whole lot more sense" than the survey procedure states now use, said AHCA spokeswoman Linda Keegan.
"The checklist approach and inspection approach doesn't really make sense and doesn't measure outcomes,"
In July 1995, HCFA implemented new nursing home quality-enforcement regulations required by a 1987 law. Those regulations increase the range of penalties that state inspectors can impose on nursing homes and require that nursing facilities be inspected on a statewide average of once a year.
Some long-term-care providers wanted HCFA to delay implementation of those regulations because some state enforcement agencies hadn't finished training their inspectors.
(r)$âG.ˆ»In the South Dakota pilot program, nursing homes will compare their performance to a base line. If performance falls below that base line, the state can call for a review and action plan. That's similar to provisions in the enforcement regulations under which state inspectors can order nursing homes to develop a correction plan.
The consumer satisfaction component will involve surveys of residents and their families. Keegan said the nursing homes will measure themselves against consumers' expectations, which will be based on some research already completed in focus groups and wider-scale polling. Nursing homes will supply consumer satisfaction data to the state quarterly.
Bachman said one goal of the consumer surveys is to reduce the number of complaints against nursing homes. She added that work on the surveys has not been completed.