Toward a National Health Information Infrastructure: A Key Strategy for Improving Quality in Long-Term Care. A. Comparison of Terms: ACOVE Indicators, Domain Experts, and QIs/QMs

05/01/2003

Table 1, Table 2, and Table 3 compare the terms we abstracted from three sources: the ACOVE indicators, the domain experts, and the MDS quality indicators and quality measures. To facilitate comparisons and analyses, we grouped data elements into the broad categories of targeted history and physical, treatments for condition, and assessments. It is important to remember that we asked the domain experts to suggest data elements that would be required to assess quality of care; therefore most of the terms from the domain experts reflect assessments. The relative lack of detail of terms related to treatments should not be interpreted as indicating the expert would not or could not recommend treatments. Our request to the domain experts emphasized a request for data elements that are associated with assessment indicators for each of the specific conditions.

It is striking to note that across these three tables, the number of terms dramatically diminishes as one moves from the domain experts and ACOVE indicators to the MDS data elements. This reflects the limited scope of the MDS, and subsequently the limited data available for making decisions related to the quality of care. The terms provided by the ACOVE indicators and the domain experts reflect the far more extensive data typically recorded (and available) in clinical records.

The difference in the number of terms also reflects an emphasis by the ACOVE documents and the domain experts that quality judgments must be associated with clinical decision-making, in contrast to summary measures of quality that are reflected in incidence and/or prevalence rates that emphasize counting events. The ACOVE groups and the domain experts emphasized that it is the failure to identify persons who might benefit from related processes of care and to then provide that care that is one of the most significant indicators of poor quality. The MDS quality indicators and measures emphasize the incidence and prevalence of events, i.e., the occurrence of pressure ulcers, pain, and incontinence -- not the timely detection and early intervention to prevent those events from occurring.

Given the limited coverage provided by the MDS quality indicators and quality measures for the targeted domains, we felt it was important to also examine the content coverage of the entire MDS in relation to the ACOVE indicators and domain expert terms in order to determine whether the indicators recommended by the ACOVE manuscripts and the domain experts could be derived from MDS data elements. This review is provided below in the section entitled, "Content Coverage for Domain Expert Terms." Unfortunately, even when examining the entire content of the MDS, the MDS does not provide much of the data content recommended by the ACOVE documents or the domain experts.

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