Discuss and compare outcomes-based measures and process-based measures

Chapter 12

Long-Term Care Quality

Learning Objectives

Understand the concept of quality improvement and how it applies to
long-term care

Identify the similarities and differences between quality assurance and continuous quality improvement

Discuss and compare outcomes-based measures and process-based measures

Learning Objectives (continued)

4. Discuss the value of a systemwide approach to management of quality

5. Identify government and private resources available to assist providers’ quality improvement programs

Defining Quality

Means different things to different people

A matter of judgment

Measures “goodness”

Involves both technical care and interpersonal exchanges

Quality of life is increasingly important

Measuring Quality

Most common measurement methods:

1. Process

2. Structure

3. Outcomes

Quality Initiatives

Two categories:

External – Systemwide

Internal – Provider-administered

Systemwide Quality
Improvement Programs

Government initiatives:


Public information initiatives

Quality-related research

Regulation of Quality

History of quality regulation:

Quality assurance

Minimum data set (MDS)


Quality improvement organizations (QIO)



Public Information Initiatives

Nursing Home Compare

Five-Star Quality Rating system

Quality-Related Research


National Library of Medicine

Private Quality Programs

Private initiatives:

Quality First

Organizational programs (AHCA/NCAL, AQNHC, AHQA, NQF)

Advancing Excellence in America’s Nursing Homes


Private foundations

College and university research institutes

Internal (Provider-Administered) Quality Improvement Programs

Quality Assurance (QA)

Continuous Quality Improvement (CQI)

Quality Improvement (QI)

Developing a QI Program

Need top-level support

Must be mission based

Define the organization’s customers

Determine standards

Measure against standards

Evaluate data

Take steps toward improvement

Ongoing measurement and evaluation

Quality Teams

May have several teams

Each team:

  • Is multidisciplinary
  • Includes those closest to the topic area
  • Includes others based on expertise
  • Reports to a central committee


Improved data collection and interpretation using information technology:


More accurate

Easier to store data


Long-term care quality is difficult to define and measure. Yet, numerous initiatives by providers, government, and outside agencies show a strong commitment to quality and progress.