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Provider perspectives on how to effectively present information on quality

June 1, 2007
by FARIDA KASSIM EJAZ, PHD and BRENDA PETERS, MA
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Focus groups discuss collecting and presenting data for quality improvement purposes. A review of the findings

Information on nursing home quality via online data sets such as Nursing Home Compare and numerous trade journals such as Nursing Homes/Long Term Care Management has become increasingly popular. Literature suggests that researchers or government bodies collecting information on quality often struggle to find ways to present the data in a format that is useful to providers without becoming overwhelming or burdensome.1 A great deal of money and effort has been invested in generating knowledge that could potentially shape decisions about health and healthcare and for providers to improve quality of care.2,3,4 However a major concern about this knowledge transfer is that “take-home messages” are not always clear to intended audiences.2,5 Other reports on the use of publicly reported comparative information on health plans and hospitals indicate that providers, consumers, and regulators have paid little attention to comparative quality information either in print or from online sources.6

Our research team at Benjamin Rose's Margaret Blenkner Research Institute in Cleveland, Ohio, conducted focus groups with providers to find out how they prefer to receive information on quality of care, satisfaction data, and related topics for quality improvement (QI) purposes.

Methods and Sample

We implemented a mixed methods approach using focus group methodology, as well as a structured questionnaire, to collect provider opinions.

Short survey. Before the start of the focus groups, participants completed a short questionnaire to collect information on background characteristics and obtain ba-sic report and Web site preferences.

Focus groups. Two focus groups were convened with members of two Ohio trade associations. Each focus group discussion was tape-recorded and lasted about two hours. The first focus group was conducted with members of the Ohio Health Care Association (OHCA), the Ohio counterpart of the American Health Care Association, whose members were employed primarily by proprietary nursing homes. This focus group was held following a meeting of the association's Facility Standards Committee and Nursing Council in Columbus, and members from all over the state attended.

The second focus group was a special event organized specifically for this study to balance the first group. These providers are members of HealthRays Alliance, a consortium of 15 long-term care, nonprofit organizations in Northeast Ohio. Alliance members also belong to AOPHA, the Ohio counterpart of the American Association of Homes and Services for the Aging.

Focus group structure. We developed open-ended questions to guide the discussion. We also created sample reports from a number of online reports, including information on quality indicators, deficiencies, and consumer satisfaction. Our data sources included the Nursing Home Compare Web site of the Centers for Medicare & Medicaid Services (CMS; http://www.medicare.gov/NHCompare/home.asp) and Ohio's Long-Term Care Consumer Guide (http://www.ltcohio.org), sponsored by the Ohio Department of Aging.

The sample reports were used to generate a discussion of impressions of current reporting strategies, how research data should be reported to providers, formats that providers found easiest to follow, and preferences for comparisons with other facilities. We asked whether providers needed technical assistance in using such information for QI purposes and which publications they read to learn about such findings.

Findings From the Short Survey

Background characteristics of partici-pants. Twenty women and seven men attended the two focus groups, with an average age of 45.3 years; 54% were college graduates, 35% had a master's degree, and 12% had attended some college. Most were Caucasian, with one African-American participant. Their job titles included administrator or director of nursing, director of clinical services, and risk manager. Most of these job titles could be classified as administrative (63%) or nursing/clinical (37%) positions. Participants had worked in their current facilities an average of 6.3 years, but had been employed in the long-term care field an average of 18 years.

Background information on sites. Participants represented 18 different nursing homes—15 from organizations that were part of a chain—and 3 from organizations that managed, advocated, or provided consulting services for nursing homes in Ohio. The nursing homes and their umbrella organizations provided a broad range of services, including skilled nursing services, respite, hospice, subacute care, home care, assisted living, independent living, and dementia/Alzheimer's care. The organizations were located in suburban (35%), rural (30%), or urban (13%), settings, and some (22%) organizations had multiple types of locations.

Findings From the Focus Groups

Participants agreed that, to be most effective for providers and consumers, reports should be simple. They felt that tables with numbers and percentages were generally appropriate and easy to understand for most audiences. While they agreed that bar graphs are easy to understand, they felt that they waste space. They also suggested that additional in-depth information may be useful and most appropriate in electronic formats, perhaps as a hyperlink on a Web page.

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