AHRQ Study Examines Nursing Homes With Pay-for-Performance Programs

Creating a reimbursement context that facilitates the collection and use of reliable local evidence is an important consideration for nursing home leaders contemplating pay-for-performance policies, AHRQ-funded researchers concluded in a study in BMJ. Pay-for-performance programs are used in organizations aiming to improve the quality of care. This study explored ways in which data were collected and used as a result of participation in a pay-for-performance program. Interviews were conducted with 232 employees from 70 nursing homes that participated in pay-for-performance-sponsored quality improvement projects. Interviewees included supervisors, nurses and nursing assistants, therapists, other patient care staff and administrators. Researchers found that data and evidence played an important role in quality improvement project implementation. Nursing home staff discussed using data to identify problems, track progress, motivate employees and increase the marketability of the organization. The study and abstract, “Pay-for-Performance Policy and Data-Driven Decision making Within Nursing Homes,” appeared online March 6.

2015 May;24(5):311-7. doi: 10.1136/bmjqs-2014-003362. Epub 2015 Mar 6.

Pay-for-performance policy and data-driven decision making within nursing homes: a qualitative study.

Abrahamson K1, Miech E2, Davila HW3, Mueller C3, Cooke V4, Arling G1.

Author information

Abstract

INTRODUCTION:

Health systems globally and within the USA have introduced nursing home pay-for-performance (P4P) programmes in response to the need for improved nursing home quality. Central to the challenge of administering effective P4P is the availability of accurate, timely and clinically appropriate data for decision making. We aimed to explore ways in which data were collected, thought about and used as a result of participation in a P4P programme.

METHODS:

Semistructured interviews were conducted with 232 nursing home employees from within 70 nursing homes that participated in P4P-sponsored quality improvement (QI) projects. Interview data were analysed to identify themes surrounding collecting, thinking about and using data for QI decision making.

RESULTS:

The term 'data' appeared 247 times in the interviews, and over 92% of these instances (228/247) were spontaneous references bynursing home staff. Overall, 34% of respondents (79/232) referred directly to 'data' in their interviews. Nursing home leadership more frequently discussed data use than direct care staff. Emergent themes included using data to identify a QI problem, gathering data in new ways at the local level, and measuring outcomes in response to P4P participation. Alterations in data use as a result of policy change were theoretically consistent with the revised version of the Promoting Action on Research Implementation in Health Services framework, which posits that successful implementation is a function of evidence, context and facilitation.

CONCLUSIONS:

Providing a reimbursement context that facilitates the collection and use of reliable local evidence may be an important consideration to others contemplating the adaptation of P4P policies.

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