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.

Short-stay nursing home rehabilitation patients: transitional care problems pose research challenges.

A clinical intervention pilot study to improve depression care for short-stay nursing home Medicare-reimbursed rehabilitation patients funded by the National Institute on Aging was conducted. Despite solid theoretical and clinical grounding and the support of a large nursing home company, several roadblocks to implementation were encountered, including involving patients and families, communication between providers, involving community primary care physicians, staff time constraints, and conducting research with short-stay patients. Although frustrating from a research standpoint, these roadblocks closely reflect problems identified by the American Geriatrics Society as impeding the delivery of high-quality transitional care in geriatrics.