Medicare Post-Acute Care: Quality Measurement Final Report. APPENDIX J. Issues for Second Expert Panel Discussion

9:30 - 10:30 Discussion Session

  1. The first expert panel rated a long list of both global and disease specific quality indicators. In the final rank list (Appendix F of this report), the majority of the indicators were global and these indicators served as the basis for the quality measures included in the instruments. Please comment on the balance between the global and disease-specific measures in the patient survey and chart review instruments for the respective condition.

  2. Do you think that the measures chosen reflect the quality constructs recommended by the initial expert panel (please see Appendix F)?

  3. Are there measures relevant to the post-acute care of older adults that were not included in these quality measurement instruments?

10:45 - 12:15 Discussion Session

  1. In your opinion, can the current quality measures be feasibly administered in the respective post-acute care settings?

  2. Do you anticipate that these measures will be responsive for detecting clinically important change?

  3. Do you foresee problems with floor or ceiling limitations? For example, subjects who cannot perform a given self-care function at baseline cannot recover that function; therefore creating a floor effect?

  4. The purpose of this study will be to compare quality of care across settings. Do you have recommendations for sampling comparable populations in different post-acute settings?

  5. With respect to selection criteria for study subjects, which post-acute care patients would be most appropriate for quality of care comparison (i.e., not all patients have the condition of interest listed as their primary diagnosis; what techniques could be used to identify a sample of comparable patients across the three different post-acute settings so as to make quality comparisons across settings?). How could potential subjects be identified in the absence of information derived from the MDS/MDS-PAC/OASIS?

1:15 - 2:15 Discussion Session

  1. What defines a discrete episode of care for this condition in post-acute care? In particular, what defines the end of a post-acute episode (e.g., rehospitalization? a certain length of time such as 30 days? discharge from the post-acute care provider?). This definition will determine when the follow-up measures are administered.

  2. Ultimately these measures will be used for quality comparisons between sites of post-acute care. What variables would you recommend for case mix adjustment?

  3. Given the importance of assessing quality, do you feel that the current instruments impose excessive response burden on older patients?

2:30 - 3:30 Discussion Session

  1. What criteria would you suggest for determining the need for a proxy respondent? Do you have any experience with particular mental status instruments in post-acute care?

  2. Do you feel that the measures in the chart review instruments can be reasonably abstracted from the post-acute care and hospital charts?

  3. Do you feel that the quality measures accurately capture key elements for comparing quality for which post-acute care providers can be held accountable?

3:45 - 5:00 Discussion Session

  1. Do you believe it is possible to construct a summary performance measure using the measures in these instruments? If so, how would such a measure be constructed and the various domains weighted?