Measuring Rehab Outcomes
How does QIS address
rehabilitation and community
Skilled nursing facilities (SNFs) are the largest provider of post-acute rehabilitation care and treat the most varied and disabled rehabilitation population. The challenge in SNF rehabilitation is unique: optimizing functional outcomes for frail patients with multiple limitations.
The most widely used measures of rehabilitation outcomes are based on setting-specific data that are collected for clinical purposes to monitor patient progress, make treatment decisions, and/or determine resource needs. For example, MDS functional data are used to objectively identify and monitor deficits at a granular level in order to optimize treatment. From the perspective of measuring and tracking rehabilitation quality, however, more global measures of outcome are of greater value.
Thus, the most important QIS measure of rehabilitation performance for patients who are receiving therapy services in the Admission Sample is return to living in the community or to one’s prior living situation. For a great many patients undergoing rehabilitation following acute events, returning to their prior living situation is the most important outcome. If they cannot return to their prior living situation, they are interested in returning to the most independent setting possible. This measure is influenced by care provided by nursing staff, physicians, and social workers, as well as the type and intensity of physical, occupational, and speech therapy.
The QIS Admission Sample Record Review assessment in Stage 1 contains QP071, Lack of Community Discharge.
For residents who are receiving physical, occupational, and/or speech therapy, this QCLI examines whether they were discharged back to the community within 60 days of admission. Exclusions for this QCLI include residents who are receiving end-of-life care or have severe cognitive impairments.
For many nursing home admissions, community discharge is not expected. Thus, the threshold for this QCLI is relatively high compared with many of the others in QIS. This is because the survey is seeking to identify facilities where there is a prevailing pattern of admitted residents who receive therapy but are not ultimately discharged to community.
When the threshold is exceeded, it leads to a more detailed review of rehabilitation care.
For a more complete discussion of rehab measures, see my chapter in the “2011 Annual Quality Report” published by the American Health Care Association and the Alliance for Quality Nursing Home Care.