Media Release

For: Immediate Release
Date: April 24, 2002
Contact: Robert J. Marshall, Ph.D. 222-1017

RI and CMS Release New Information on Nursing Home Quality
6-State Pilot Project Leads Nationwide Effort

April 24, 2002 – Data on nursing home quality are now available to the public for nearly all Rhode Island nursing homes. Rhode Island is one of six states participating in a quality improvement pilot project designed by the Centers for Medicare & Medicaid Services (CMS) to help nursing homes improve quality of care and to assist consumers in finding the best nursing home for their needs. CMS posted the data for all six states on its website today. RI now makes the state-specific data available in a special format on the Department of Health (HEALTH) website (www.health.ri.gov).

The information being released today will help the state meet the requirements of the Health Care Quality Reporting Act, introduced by Lt. Gov. Charles J. Fogarty--under which the state, for the first time ever, recently released consumer satisfaction data for all the state's community hospitals. The act, commonly referred to as the Fogarty Law, was authored and passed in 1998 by then-Senator Fogarty and requires the state to develop and report publicly on quality measures for all licensed health care facilities.

"By publicly reporting these and other measures, consumers and health care professionals will have one more tool with which to make decisions and health care providers will have the information they need to improve their care by sharing best practices," said Lt. Governor Charles Fogarty.

The HEALTH website identifies 97 of 103 Rhode Island nursing homes by location and rates each one on nine clinical measures. Facilities ranked in the bottom 15 percent for each clinical measure receive one "diamond." Those ranked among the top 15 percent receive three "diamonds". Six facilities do not participate in the Medicaid program, a requirement to be in the pilot project.

Officials introduced the HEALTH website today. They included: Dr. Patricia A. Nolan, Director of Health; Lt. Governor Charles Fogarty; Dr. Barbara Paul (CMS), Dr. David Gifford of Rhode Island Quality Partners (RIQP), the quality improvement organization coordinating the project in Rhode Island; Al Santos from the RI Health Care Association and Sheila Cabral Sousa from the RI Assoc. of Facilities and Services for the Aging.

"Quality health care is extremely important to Rhode Islanders," said Dr. Patricia Nolan. "This report brings us a step closer to complete measurement and reporting on quality in nursing homes, hospitals and other facilities. Just publishing these measures can help improve care. When people use this report to make decisions about health care, they should remember how complex nursing home decisions are. To get the full benefit, we recommend discussing the report with the staff of the nursing home you are considering."

Six of the nine quality measures reflect care given to patients with chronic conditions, or residents likely to remain in facilities long term. These include physical restraints, pressure sores, weight loss, infections, pain management and decline in activities of daily living. The remaining three measures, managing delirium, pain management and improvement in walking, reflect care given to post acute residents, or those in facilities during the first couple of weeks following a hospital stay.

Those involved with the project emphasize that patients and their families should consider several sources of data when looking at quality of care overall.

"There are several factors to consider when choosing a nursing home. These measures are only one piece of important information," says Roberta Hawkins, Executive Director of the Alliance for Better Long Term Care, the state’s long term care consumer advocacy agency. Hawkins points out that location, cleanliness, activity level and how the residents are treated are important determinants when choosing a nursing home. "Families and residents should not immediately assume that a lower score on any of the measures means a bad nursing home. It’s important to visit facilities and speak with staff, residents and families " she adds.

The primary objective of the public reporting projects is to improve the quality of care in nursing homes. In addition to publishing quality data, Medicare quality improvement organizations in each of the pilot states will work with nursing homes on projects to improve their systems of care. The pilot project is intended to assess the manner in which the data is reported and how to best assist nursing homes to improve quality, says Gifford.

"The quality measures are adjusted for the types of residents that may cause different results for some nursing homes--even though they provide similar care," said Dr. Gifford. In order to adjust for these differences, the methodology excludes specific residents that may make the results non-comparable. In addition, the analysis applies a statistical adjustment to three of the measures (weight loss, delirium and pain) to make the populations in each nursing home similar.

However, Roberta Hawkins cautions that these "risk adjustment" approaches may not work well for some nursing homes, particularly those that specialize in certain conditions or problems. Therefore, consumers are encouraged to ask nursing home staff about these quality measures.

Rhode Island Quality Partners worked with many agencies to complete the project. These include the RI Departments of Health, Human Services (DHS), Elderly Affairs (DEA) Lt. Governor Charles Fogarty, Aging 2000, the Rhode Island Health Care Association, the Rhode Island Association of Facilities and Services for the Aging, CareLink and the Alliance for Better Nursing Home Care, Brown University, the College of Health Care Administrators and several nursing home administrators. Regular public reporting for all 50 states is expected to commence no earlier than October 2002. The other five states participating in the pilot project are Colorado, Maryland, Washington, Ohio and Florida.

The new nursing home information for the Rhode Island facilities can be viewed on www.health.ri.gov. The CMS website, www.medicare.gov posts data from all six pilot states. Further information is available through the RI Department of Health at (401) 222-4872, or CMS at 1-800-MEDICARE.