In this National Report of Nursing Home Quality Measures and Information Technology, AHRQ will support an interdisciplinary research team who are already contributing to clinical research in long-term care settings. The PI is a doctorally-prepared RN and fellow in the American Academy of Nursing with over two decades of work in diverse projects, settings, and disciplines. Additional leadership includes experts in informatics including health information technology (IT), long term care, survey methodologies, statistics, and nursing homes have been assembled to guide this study. The research strategy includes a 4 round Delphi Technique with 30 NH IT experts to validate a NH IT Maturity survey that includes 29 content areas in resident care, clinical support, and administrative activities. Delphi experts will help also develop a NH IT maturity staging model based on NH IT capabilities, extent of IT use, and IT integration. Delphi expert opinion regarding the the NH IT Maturity scale and staging model will be combined to form a new survey that will be used to measure NH IT Maturity nationally, in the U.S. The team will conduct a pilot test of the new survey, prior to the national survey, to examine validity of the instrument. The pilot study will be conducted with 24 respondents who participated in the initial national NH IT sophistication study. These respondents will be recruited from a pool of 223 NHs participating in original research with diverse total IT sophistication measures (HIGH, MEDIUM, and LOW). Once the NH IT Maturity survey is validated, the team will conduct a three-wave, longitudinal, repeated measures study measuring NH IT Maturity in a national sample of NHs. Methods include an examination of the relationships between NH IT Maturity and stages of maturity, and nationally-reported, publicly-available NH Quality Measures available through Nursing Home Compare over three consecutive years.
Specific aims are: 1) Create a NH IT maturity survey and maturity staging model using a 4 round Delphi with NH IT experts, 2) Pilot test the NH IT Maturity Survey and staging model with NH IT experts, 3) Explore NH IT maturity using the survey and staging model during a 3-year national assessment, and 4) Examine if NH IT maturity is associated with CMS quality measures in a national sample of NHs over 3 years. The project is highly innovative; national assessments of NH IT Maturity and maturity stages have not been measured previously or linked with national NH Quality Measures. This study includes a survey of NH IT Maturity in a nationally representative sample including 10% of NHs recruited from each state in the United States (N=1,570). Statistical analysis will be done using the software SAS v9 (SAS Institute Inc., Cary, NC, USA). Since the sampling method involves stratification by state and since the sampling weights assigned to homes will depend on the number of respondents within each state, the analysis must take the complex sampling design into account. SAS procedures such as SURVEYMEANS, SURVEYFREQ, SURVEYLOGISTIC, and SURVEYREG will be used for such analyses.

Public Health Relevance

This research is closely tied to AHRQ?s health information technology, value, and long term care portfolios. Nurses continue to bear great burdens for millions of patients in nursing homes; yet, issues persist with poor quality, variable performance of caregiving, and lack of implementation of proven care interventions. One new hope for quality improvement in nursing home care is the strategic management decision to implement IT to improve communication, clinical decision-making, and quality of care in these long term care organizations.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project (R01)
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Healthcare Information Technology Research (HITR)
Program Officer
Burgess, Denise
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Columbia University (N.Y.)
Other Health Professions
Schools of Nursing
New York
United States
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Alexander, Gregory L; Madsen, Richard W; Miller, Erin L et al. (2017) A national report of nursing home information technology: year 1 results. J Am Med Inform Assoc 24:67-73
Alexander, Gregory L; Madsen, Richard W (2017) A Report of Information Technology and Health Deficiencies in U.S. Nursing Homes. J Patient Saf :
Alexander, Gregory L; Madsen, Richard W; Miller, Erin L et al. (2017) The State of Nursing Home Information Technology Sophistication in Rural and Nonrural US Markets. J Rural Health 33:266-274