Medicare Post-Acute Care: Quality Measurement Final Report. E. Instrument Limitations


The four instruments were revised on a continuous basis, based on insights gained from both the expert panel meeting and local pilot testing. Although the instruments underwent several rounds of revisions based on these insights, there remain some limitations with their use. First, the reliability and validity of the instruments require further testing. Pilot test sample sizes for both the admission and telephone follow-up interviews were very small. Second, the instruments rely heavily upon patient-reported information. While patient report measures are necessary in researching such domains as health-related quality of life, mental health, depression, social/role function, and satisfaction with care, it may not be feasible to utilize such measures for ongoing quality monitoring purposes. Third, the validity of the satisfaction measures included in these instruments -- as of all health care satisfaction measures -- is subject to factors such as the subject’s reluctance to discuss quality of medical care, reduced expectations, unwillingness to complain, and fear of retaliation. In addition, as previously mentioned, the time point (admission, follow-up, or other) at which satisfaction should be assessed is unclear. And finally, although these instruments contain both global and disease-specific components for the four conditions, they are weighted more heavily toward global measures of quality. Although some may argue that more disease-specific measures should be incorporated, the ratings of the expert panel members indicated that more emphasis should be placed on global measures that are relevant to all patients served in post-acute care settings.