Reporting quality of nursing home care to consumers: the Maryland experience.

Full Abstract

OBJECTIVE:
To design and implement a reporting system for quality of long-term care to empower consumers and to create incentives for quality improvement. To identify a model to approach this technically and politically difficult task.

APPROACH:
Establishment of a credible and transparent decision process using a public forum. Development of the system based on:
(1) review of the literature and existing systems, and discussions with stakeholders about strengths and weaknesses; (2) focus on consumer preferences in the design; and (3) responsiveness to industry concerns in the implementation.

LESSONS LEARNED:
None of the existing systems appeared to be a suitable model. We decided to develop an entirely new system based on three key design principles that allowed us to tailor the system to consumer needs:
(1) designing a decision tool rather than a database; (2) summarizing rather than simplifying information; and (3) accounting for the target audience in the creative execution. Industry concerns focused on the burden of the system, the potential for errors, and the possible communication of a negative impression of the industry. As methodological and data limitations prevented us from resolving those concerns, we addressed them by using cautionary language in the presentation and by making a commitment to incorporate improvements in the future. All stakeholders regarded the final design as an acceptable compromise.

CONCLUSIONS:
Despite its potentially controversial nature and many methodological challenges, the system has been well received by both the public and the industry. We attribute this success to two key factors:
a collaborative decision process, in which all critical design and execution choices were laid out explicitly and debated with stakeholders in a public forum, and realism and honesty regarding the limitations of the system.

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Author information

Author/s: Mattke, Sören (S); Reilly, Karen (K); Martinez-Vidal, Enrique (E); McLean, Barbara (B); Gifford, David (D);

Affiliation: Abt Associates Inc., Cambridge, MA, USA. soeren.mattke@oecd.org

Journal and publication information

Publication Type: Journal Article

Journal: International journal for quality in health care : journal of the International Society for Quality in Health Care / ISQua (Int J Qual Health Care), published in England. (Language: eng)

Reference: 2003-Apr; vol 15 (issue 2) : pp 169-77

Dates: Created 2003/04/22; Completed 2003/08/05; Revised 2004/11/17;

PMID: 12705711, status: MEDLINE (last retrieval date: 11/6/2008)

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