Measuring healthcare outcomes to improve quality of care across post--acute care provider settings

Justifying Rehabilitation Intensity Through Functional Performance Measures in Postacute Care

The Centers for Medicare and Medicaid Services (CMS) has scrutinized the provision of rehabilitation services in skilled nursing facilities (SNFs) for some time. Little research guidance exists on appropriate dosage or rehabilitation intensity (RI) among SNF patients or patients in other postacute care (PAC) settings. CMS developed a PAC assessment, the Continuity Assessment Record and Evaluation (CARE) Tool, in response to questions about what issues drive placement in various PAC settings under Medicare. The ability to adequately assess functional outcomes and correlate them to the RI provided by using the CARE Tool is promising. However, further research, policy advocacy, and practice analysis must be undertaken to promote and protect adequate access to occupational therapy and physical therapy in SNFs and other PAC settings. Individual practitioners must participate in data gathering to ensure that the data for analysis are fully informed by the occupational therapy perspective.

Measuring quality in long-term care: a 360-degree approach

Policy makers and providers have taken steps to address quality concerns in acute and Long-term care (LTC); however, serious quality problems remain. Efforts to measure quality have focused primarily on technical quality, assessing whether certain healthcare outcomes are achieved. Advocates for a patient-centered approach urge a shift to an assessment of functional quality that would include an overall evaluation of the service encounter that is heavily reliant on input from the service recipient. This article provides a discussion of why measuring quality in LTC is more challenging. Because a more comprehensive approach to quality is warranted in LTC, recommendations are made for using a 360-degree approach.