The need for reliable, scientifically-based information about nursing home quality is growing. Data on nursing home quality from periodical surveys by states called the On-line Survey Certification and Reporting (OSCAR) system will he used to create an information system. This project has six aims: (1) to identify critical process and outcome dimensions and indicators of quality in nursing home facilities using data from OSCAR; (2) to develop and test a model for providing consumer information about nursing homes available from OSCAR data; (3) to describe nursing home characteristics, staffing levels, resident characteristics, and process/outcomes of quality from OSCAR data in the 1990-94 period; (4) to develop a method to take into account the effect of resident characteristics and regional differences on quality dimensions; (5) to test the usefulness of the developed information system for consumers, professionals, and surveyors and make modifications as necessary; and (6) to present the information on all nursing homes and disseminate it to the public. Phase I of the project involves the preparation of the OSCAR data by cleaning and examining descriptive data. Phase II will develop the quality dimensions/indicators from OSCAR by collecting opinions from a broad range of informants and using decisions by an expert panel. It is expected that about 5-10 dimensions of the processes of care (nursing care, residents' rights etc.) and 3-5 dimensions for outcomes of care will he developed with 3-8 key indicators to define each dimension. In Phase III, data analyses will be conducted to develop a consumer information system. A confirmatory factor analysis using LISCOMP will assess the dimensions and indicators selected by the Expert Panel from the OSCAR data. The effects of casemix on the quality dimensions and indicators will be examined and risk adjustments will be made where necessary. Adjustments for regional variations will be made if regional differences in quality are identified. Convergent validity will be tested by comparing the OSCAR information with an independent set of quality indicators (QIs) from the MDS+ data. The stability of the model over time will he tested using fife years of data (1990-1994). Phase IV will test the usefulness of the information system on selected criteria as judged by an informal survey of consumers, surveyors, and providers and by the expert panel. Phase V will develop information for each of the 16,500 nursing homes in the U.S. on structural, process, and outcome dimensions for each of the five years. Phase VI will develop the final reports and disseminate the reports to the public. The ultimate goal is to develop a model of consumer information for nursing homes that can be periodically disseminated to the public on a regular basis for a relatively low cost.
