Toward a National Health Information Infrastructure: A Key Strategy for Improving Quality in Long-Term Care. Quality Indicators and Quality Measures

Third, a list of the MDS data elements associated with the quality indicators and quality measures was compiled. Quality indicators derived from MDS data were described earlier in this paper. The pressure ulcer quality indicator is "Prevalence of stage 1-4 pressure ulcers" and is derived from the single MDS data element "pressure ulcer -- any lesion caused by pressure resulting in damage of underlying tissue." Two quality indicators are relevant to incontinence: "Prevalence of bladder or bowel incontinence" and "Prevalence of occasional or frequent bladder or bowel incontinence with or without a toileting plan." The respective MDS data element is "Control of urinary bladder function or continence programs, if employed." This data element is then coded according to whether the individual is usually continent, occasionally incontinent, frequently incontinent, or incontinent all of the time. Appendix C includes examples of data from the MDS used to derive quality indicators related to pressure ulcers and incontinence. There is not a quality indicator for chronic pain.

The nursing home quality measures are derived from MDS data elements, as are the quality indicators. The quality measures of interest in this study are related to residents with pressure sores and pain. For the measure of prevalence of stage 1-4 pressure ulcers, the MDS data element is the same pressure ulcer data element listed above, with a risk adjustment factor based on the data elements "impaired transfer or bed mobility" or "comatose" or "malnutrition" or "end stage disease." For the measure of inadequate pain management, the MDS data elements include "residents with moderate pain at least daily" or "horrible/excruciating pain at any frequency." This measure is covaried by the MDS data elements "independence in decision making." Appendix D includes examples of data from the MDS used to derive quality measures related to pressure ulcers and pain.

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