Usefulness of the Nursing Home Quality Measures and Quality Indicators for Assessing Skilled Nursing Facility Rehabilitation Outcomes

Silverstein B, Findley PA, Bode RK. Usefulness of the nursing home quality measures and quality indicators for assessing skilled nursing facility rehabilitation outcomes.ObjectiveTo examine the usefulness of the nursing home quality indicators and nursing home quality measures for differentiating among providers from a rehabilitation outcomes perspective.DesignRetrospective.SettingSkilled nursing facilities (SNFs) across the United States.ParticipantsA total of 211 SNFs.InterventionsNot applicable.Main Outcome MeasuresAll quality indicators, all quality measures except for CWLS01 (residents who lose too much weight), and a set of rehabilitation outcomes including residualized FIM motor gain, the percentage of patients discharged to community, and the percentage of patients reporting “quite a lot” or “completely” prepared to manage their care at discharge from SNF-based rehabilitation.ResultsNo quality measures correlated with any rehabilitation outcomes. Residualized FIM motor gain did not correlate with any quality indicators or quality measures. Only 1 quality indicator—prevalence of daily use of restraints (QI 22)—correlated with the rehabilitation indicator community discharge percentage. The third rehabilitation indicator, prepared to manage care at discharge, correlated (negatively) only with QI 18 incidence of decrease in range of motion. Among the rehabilitation outcomes, residualized FIM motor gain correlated significantly with both community discharge percentage and prepared to manage care at discharge.ConclusionsPatients and referrers choosing SNF-based medical rehabilitation need tools that differentiate among prospective providers from a rehabilitation outcomes perspective. Data in this study indicate that nursing home quality indicators and quality measures are inadequate for this purpose.