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Assessing and Improving Patient Safety Measurement in Nursing Homes

Award Number: R01HS026957
ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY
OPDIV: AHRQ
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 08/01/2019
PERIOD OF PERFORMANCE END DATE: 05/31/2024

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Assessing and Improving Patient Safety Measurement in Nursing Homes - Project Summary Nursing homes house vulnerable people who may have physical and psychological limitations and also often lack the financial, political, and social means required for advocacy. To ensure people in nursing homes are safe and receiving high quality of care, public monitoring of these facilities is crucial. A core part of current efforts to monitor and improve patient safety in nursing homes rely on the Minimum Data Set 3.0 (MDS), which contains patient-level health assessments that are self-reported by nursing homes. The Centers for Medicare and Medicaid Services quality measures and five-star ratings based on these assessments suggest progress has been made over the past decade. However, in light of inconsistencies between the MDS and other data sources, and investigations and audits that suggest MDS reporting may be unreliable, it is reasonable to question the integrity of the data and thereby the current federal approach to monitoring nursing home patient safety. We propose to use Medicare and Medicaid claims of nursing home patients to identify health events that led to hospital visits. Our focus will be on four patient safety sections of the MDS, namely falls, pressure ulcers, urinary tract infections (UTIs), and pneumonia, all of which are generally preventable but without proper care can lead to serious physical and psychological morbidity and mortality. This will allow assessment of the quality of reporting on the MDS, our first aim. The guiding principle here is that while only a portion of the cases that occur in nursing homes would be serious enough to warrant a hospital visit, all cases that result in a hospital visit should be appropriately recorded by the MDS. We will also assess variations in MDS reporting accuracy by patient and nursing home characteristics, with a particular focus on identifying disparities by race and Medicaid enrollment. In our second aim, we will estimate changes in MDS reporting behavior after major injury falls were included in the five-star ratings calculations. In the third aim, we will use the claims to develop alternative measures of patient safety in nursing homes, that is the incidence rates of the more severe cases of these clinical conditions. We will assess the associations between these claim-based rates and other measures of patient safety. In addition to studying these rates and their trends, we will assess variations in incidence rates by nursing home characteristics, with a particular focus on identifying disparities by race mix and proportion Medicaid. Finally, we will describe how current rankings of nursing homes may shift under the claims-based measures. This work will advance safety and quality research for the nursing home care system. It will be a crucial step towards evaluating the effectiveness of current programs and improving future efforts by the public. We will pay specific attention to race and Medicaid payer status in MDS reporting rates and our claims-based patient safety measures to identify disparities, as minorities and the poor may be especially at risk of receiving low-quality care. We expect to provide specific, evidence-based insights that policymakers can use to substantially improve patient safety tools in these settings.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2024 ( Subtotal = $0 )
2024	2022	UNIVERSITY OF CHICAGO	5801 S ELLIS AVE	CHICAGO	IL	60637	COOK	USA	Research on Healthcare Costs, Quality and Outcomes	000	4	9/26/2024	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2023 ( Subtotal = $0 )
2023	2022	UNIVERSITY OF CHICAGO	5801 S ELLIS AVE	CHICAGO	IL	60637	COOK	USA	Research on Healthcare Costs, Quality and Outcomes	000	4	8/3/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2022 ( Subtotal = $374,158 )
2022	2022	UNIVERSITY OF CHICAGO, THE	5801 S ELLIS AVE	CHICAGO	IL	60637	COOK	USA	Research on Healthcare Costs, Quality and Outcomes	000	4	6/7/2022	NON-COMPETING CONTINUATION	$374,158
														Subtotal = $374,158

Issue Date FY: 2021 ( Subtotal = $383,000 )
2021	2021	UNIVERSITY OF CHICAGO, THE	5801 S ELLIS AVE	CHICAGO	IL	60637	COOK	USA	Research on Healthcare Costs, Quality and Outcomes	000	3	5/12/2021	NON-COMPETING CONTINUATION	$383,000
														Subtotal = $383,000

Issue Date FY: 2020 ( Subtotal = $390,409 )
2020	2020	UNIVERSITY OF CHICAGO, THE	5801 S ELLIS AVE	CHICAGO	IL	60637	COOK	USA	Research on Healthcare Costs, Quality and Outcomes	000	2	6/12/2020	NON-COMPETING CONTINUATION	$390,409
														Subtotal = $390,409

Issue Date FY: 2019 ( Subtotal = $394,763 )
2019	2019	UNIVERSITY OF CHICAGO, THE	5801 S ELLIS AVE	CHICAGO	IL	60637	COOK	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	7/18/2019	NEW	$394,763
														Subtotal = $394,763

Grand Total All Awards = $1,542,330

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Assessing and Improving Patient Safety Measurement in Nursing Homes

Award Number: R01HS026957

ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY

OPDIV: AHRQ

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 08/01/2019

PERIOD OF PERFORMANCE END DATE: 05/31/2024

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