Indicators of the quality of nursing home residential care

OBJECTIVES: To identify quality indicators (QIs) that can be used to measure nursing home (NH) residential care processes. DESIGN: Modified-delphi panel process to rate potential QIs that were identified through reported interviews with residents and families and through a review of the scientific literature. SETTING: Meetings of panel of experts. PARTICIPANTS: A national panel of nine experts in NH care rated potential QIs. A content expert and a clinical oversight committee performed external reviews. MEASUREMENTS: Panelists' median validity and importance ratings for each QI choice. RESULTS: The panel considered 64 choices for QI content and rated 28 of these as valid and important for measuring residential care quality. These 28 choices translated into 18 QIs. The external review process resulted in the addition of one QI that was not considered by the NH panel. The 19 indicators address areas identified as important by residents and proxies. Ten of these QIs were rated feasible to implement with current resources in average community NHs, and nine were rated feasible only in better NHs. The panelists identified nine as being measured most reliably by direct observations of care. CONCLUSION: Experts identified 19 specific care processes as valid and important measures of the quality of NH residential care. Nine of these QIs may be measured best by direct observation of NH care, rather than by interviews or review of existing NH records. Almost half of the QIs were viewed as discriminating between better and average NHs. The panel deemed that only well-staffed nursing homes could consistently implement nine of the QIs.