Development of the Primary Care Provider Quality Score in Long-term care

Medical care in long-term care (LTC) homes requires a team of competent care providers to manage frail, vulnerable elders. Presently, there are no quality measures available to educate primary care providers (PCP), track clinician adherence to best practice guidelines, and improve the quality of care provided to LTC residents. The purpose of this project was to develop a new measure of medical care performance called the “Primary Care Provider Quality Score” (PQS) to assess the care of persons in LTC homes. The PQS would be the only discipline-specific quality measurement tool specific to the LTC sector. This project is important because it will:

• Increase confidence in care,
• Advocate for consistent, high-quality care on behalf of patients and families (patients cannot observe and assess the quality of their own care)
• Inform and educate medical care providers on competencies and guidelines
• Help PCPs to self-assess their performance and compare it with other providers within a facility, across homes, and across regions.

Feedback from the PQS will provide care providers with a clear sense of areas where they are meeting standards as well as areas that need improvement.

An international panel of experts refined a core set of 37 quality measures (QMs) to track adherence to best practices, assure consistency of care and provide valuable insight into various medical staff organizational tools. These measures were well defined so that trained abstractors could find data in resident charts. Overall, data was collected from 343 patient charts at seven major LTC organizations across North America. The project included 49 PCPs. Meaningful data was extracted for most QMs at all sites.

The research team found that 12 QMs were clearly specified and showed variation in medical practice models across participating organizations. The research team is continuing to refine and identify additional QMs in the creation of the PQS abstraction tool. Results so far indicate that there is variation in care provider practices among LTC homes in terms of: organizational structure, the inclusion of nurse practitioners, medical staff contracting, training, and the role of the medical director. Resident chart abstractions revealed that there was more variation in quality than expected and performance in one QM was not correlated with performance in all other QMs. This suggests that the PQS should be adjusted to support an educational approach for PCPs to further improve the status-quo and strive for better medical care for residents before introducing metrics that could inform public reporting. The Physican Quality Score toolkit has the potential to transform quality improvement and monitoring of medical staff in long-term care homes communities if adopted as a standard quality measure in long-term care communities across North America.