Toward a National Health Information Infrastructure: A Key Strategy for Improving Quality in Long-Term Care. Domain Experts

Second, the project team identified one content expert for each domain based on their authorship of key citations retrieved from the literature review. The experts were asked to provide a listing of key literature related to their area of expertise, and of key clinical data they believed essential to making judgments of quality of care related to their specific area. This was felt to be necessary because literature synthesis by definition requires that content be summarized; and rarely includes a full complement of terms that are potentially relevant to any given focus area. In particular, we were interested in the types of clinical documentation terms that these reviewers identified.

Pressure Ulcers and Pressure Ulcer Risk: Nancy Bergstrom, Ph.D., RN, FAAN, is the Associate Director of Aging Research the Center on Aging at the University of Texas Health Sciences Center. Dr. Bergstrom was the chair of the AHCPR panel that developed the clinical practice guidelines for the prediction and prevention of pressure ulcers in adults. She has published numerous journal articles related to the assessment and treatment of pressure sore risk for nursing home residents and was the Principal Investigator for the 1988-1994 NIH study "Nursing Assessment of Pressure Sore Risk."

Chronic Pain: Keela Herr, Ph.D., R.N. is Professor and Area Chair: Adult and Gerontology Nursing at the University of Iowa. The primary focus of her work and expertise is in the area of pain assessment in older adults. She has conducted NIH funded research to establish appropriate tools for evaluating pain intensity among the elderly population. She is currently working on the AHRQ sponsored research project, "Evidence-based Practice: From Book to Bedside: Acute Pain Management in the Elderly" that is examining interventions to improve adoption of clinical practice guidelines in health care organizations.

Urinary Incontinence: John F. Schnelle, Ph.D. is the Director of the Boren Center for Gerontologic Research at the UCLA/Jewish Home for the Aging. He has been the principal investigator on nine NIH clinical trial intervention grants designed to improve care and management in nursing homes. Dr. Schnelle has published numerous journal articles related to the assessment and treatment of urinary incontinence among nursing home residents and was part of the AHCPR panel that developed the clinical practice guidelines for urinary incontinence. He is the author of the 1991 book "Managing Urinary Incontinence in the Elderly."

The domain experts were asked, based on their expertise, to:

  • Identify and refine the key terms and concepts needed to understand quality in their domain (i.e. data elements).

  • Specify the quality inferences (and the data source(s)) that could be supported if all relevant data were available.

  • Identify the data elements (and corresponding data source(s)) needed to risk adjust these estimates of quality.

  • Provide a list of references related to their domain area.

Appendix B includes a list of the terms provided by each of the domain experts, and Appendix G a list of key literature citations provided by the domain experts.

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