New toolkit to measure quality of person-centered care: development and pilot evaluation with nursing home communities.

BACKGROUND: Increasingly, nursing home (NH) providers are adopting a person-centered care (PCC) philosophy; yet, they currently lack methods to measure their progress toward this goal. Few PCC tools meet criteria for ease of use and feasibility in NHs. The purpose of this article is to report on the development of the concept and measurement of preference congruence among NH residents (phase 1), its refinement into a set of quality indicators by Advancing Excellence in America's Nursing Homes (phase 2), and its pilot evaluation in a sample of 12 early adopting NHs prior to national rollout (phase 3). The recommended toolkit for providers to use to measure PCC consists of (1) interview materials for 16 personal care and activity preferences from Minimum Data Set 3.0, plus follow-up questions that ask residents how satisfied they are with fulfillment of important preferences; and (2) an easy to use Excel spreadsheet that calculates graphic displays of quality measures of preference congruence and care conference attendance for an individual, household or NH. Twelve NHs interviewed residents (N = 146) using the toolkit; 10 also completed a follow-up survey and 9 took part in an interview evaluating their experience. RESULTS: NH staff gave strong positive ratings to the toolkit. All would recommend it to other NHs. Staff reported that the toolkit helped them identify opportunities to improve PCC (100%), and found that the Excel tool was comprehensive (100%), easy to use (90%), and provided high quality information (100%). Providers anticipated using the toolkit to strengthen staff training as well as to enhance care planning, programming and quality improvement. CONCLUSIONS: The no-cost PCC toolkit provides a new means to measure the quality of PCC delivery. As of February 2014, over 700 nursing homes have selected the Advancing Excellence in America's Nursing Homes PCC goal as a focus for quality improvement. The toolkit enables providers to incorporate quality improvement by moving beyond anecdote, and advancing more systematically toward honoring resident preferences.

Treadmill value in apparently healthy life insurance applicants.

OBJECTIVE: The objective of this study is to assess the cost/value tradeoff of a routine treadmill requirement for life insurance applicants. For this purpose, we are interested in the treadmill's ability to provide unique information on the mortality risk in a population of apparently healthy and asymptomatic individuals, as opposed to the treadmill done for diagnostic or confirmatory purposes. MATERIALS AND METHODS: We performed a protective value study, solving for the face amount at which the mortality savings outweigh the various treadmill requirement costs. Multiple scenarios were evaluated, varying the following assumptions: percent of cases uniquely discovered through the treadmill, excess mortality associated with the treadmill, proportion of would-be applicants ending the process when confronted with a treadmill requirement, proportion of not-takens in the face of a positive treadmill, and various profitability requirements. While there is an array of information available from the treadmill, to avoid double counting effects we chose 2 representative and independent findings: abnormal ECG and low fitness (duration). Prevalence of findings and mortality associations were derived from published studies. RESULTS AND CONCLUSION: While many companies are moving to eliminate or restrict the use of treadmill testing, low break-even policy sizes were produced in virtually every iteration of our assumptions. In one variation, however, we ignored the possibility of any "fitness" findings. Under this assumption, results were roughly consistent with current industry practice. This suggests that some companies could enhance the value of their treadmill requirements by requesting Balke protocol treadmills and/or interpreting duration information. Others may want to reconsider current face amount thresholds for their treadmill requirement in light of this valuable risk-selection information.