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## Complete Summary

#### TITLE

Nursing facility chronic care: percent of residents whose ability to
move about in and around their room got worse.

#### SOURCE(S)

U.S. Department of Health and Human Services, Centers for Medicare &
Medicaid Services. National nursing home quality measures. User\'s
manual. Cambridge (MA): Abt Associates, Inc.; 2004 Nov (v1.2). 48 p.

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Outcome

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percentage of residents whose ability
to move about in and around their room got worse.

#### RATIONALE

A decline in physical activity may come with age due to muscle loss,
joint stiffness, worsening illness, fear of injury, or depression.
Residents who lose mobility may also lose the ability to perform other
activities of daily living, like eating, dressing, or getting to the
bathroom. In some cases, however, the decline measured may be temporary
and due to a short-term illness the resident is experiencing at the time
of the assessment.

A lack of movement may affect the resident in many ways. It becomes
difficult to participate in physical and social activities. Sleep
quality can suffer. The risk of heart disease, stroke, diabetes, or
blood clots can increase. Depression and anxiety can worsen. Staying in
one position, and constant pressure on the skin, can increase the chance
of pressure sores. It is important for residents to be as active as
possible.

Nursing home staff can help residents move around more. For instance,
they can encourage residents to take part in physical and social
activities, or take them for regular walks if they need help. Most
residents value being able to move about on their own and take care of
themselves. It is important that nursing home staff encourage residents
to do as much as they can for themselves and stay as active as
physically possible. Some residents will decline in their ability to
move about, even though the nursing home staff makes a good effort to
keep them more active.

This measure is one of nineteen National Nursing Home Quality
Improvement (NHQI) measures. These measures provide information to help
consumers make informed decisions about their nursing home care. The
measures are also intended to motivate nursing homes to improve their
care and to inform discussions about quality between consumers and
clinicians.

#### PRIMARY CLINICAL COMPONENT

Chronic care; locomotion self-performance

#### DENOMINATOR DESCRIPTION

All residents with a valid target assessment and a valid prior
assessment after exclusions are applied (see the related \"Denominator
Inclusions/Exclusions\" field in the Complete Summary)

#### NUMERATOR DESCRIPTION

Number of residents from the denominator whose value for locomotion
self-performance is greater at target relative to prior assessment

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A formal consensus procedure involving experts in relevant clinical,
    methodological, and organizational sciences

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Use of this measure to improve performance\
Variation in quality for the performance measured

#### EVIDENCE SUPPORTING NEED FOR THE MEASURE

Nursing home compare. \[internet\]. Baltimore (MD): Centers for Medicare
& Medicaid Services (CMS); 2000-\[updated 2008 Jan 16\]; \[accessed 2007
May 22\].

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Decision-making by consumers about health plan/provider choice\
Internal quality improvement\
National reporting

### Application of Measure in its Current Use

#### CARE SETTING

Long-term Care Facilities

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Measure is not provider specific

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Single Health Care Delivery Organizations

#### TARGET POPULATION AGE

Patients of all ages

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

About 3 million elderly and disabled Americans received care in our
nation\'s nearly 17,000 Medicare and Medicaid-certified nursing homes in
2001. Slightly more than half of these were long-term nursing home
residents, but nearly as many had shorter stays for rehabilitation care
after an acute hospitalization. About 75 percent were age 75 or older.

#### EVIDENCE FOR INCIDENCE/PREVALENCE

Nursing home quality initiative. Overview. Baltimore (MD): U.S.
Department of Health and Human Services, Centers for Medicare & Medicaid
Services (CMS); 2004 Jan 20. 3 p.

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

See \"Rationale\" field.

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Living with Illness

#### IOM DOMAIN

Effectiveness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

All residents with a valid target assessment and a valid prior
assessment

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
All residents with a valid target assessment and a valid prior
assessment

**Exclusions**\
Residents satisfying any of the following conditions:

1.  The specified locomotion self-performance value is missing on the
    target assessment.

2.  The specified locomotion self-performance value is missing on the
    prior assessment and the value shows some dependence on the target
    assessment.

3.  The specified locomotion self-performance value on the prior
    assessment is 4 (total dependence) or 8 (activity did not occur).

4.  The resident is comatose or comatose status is unknown on the target
    assessment.

5.  The resident has end-stage disease or end-stage disease status is
    unknown on the target assessment.

6.  The resident is receiving hospice care or hospice status is unknown
    on the target assessment or the most recent full assessment.

Refer to the original measure documentation for details.

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Diagnostic Evaluation\
Institutionalization

#### DENOMINATOR TIME WINDOW

Time window precedes index event

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Number of residents from the denominator whose value for locomotion
self-performance is greater at target relative to prior assessment

Refer to the original measure documentation for details.

**Exclusions**\
Unspecified

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Fixed time period

#### DATA SOURCE

Special or unique data

#### LEVEL OF DETERMINATION OF QUALITY

Not Individual Case

#### OUTCOME TYPE

Functional Status

#### PRE-EXISTING INSTRUMENT USED

CMS Minimum Data Set - Resident Assessment Instrument (Version 2.0)

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a lower score

#### ALLOWANCE FOR PATIENT FACTORS

Risk adjustment devised specifically for this measure/condition

#### DESCRIPTION OF ALLOWANCE FOR PATIENT FACTORS

Risk adjustment refines raw quality measure (QM) scores to better
reflect the prevalence of problems that facilities should be able to
address. Two complementary approaches to risk adjustment were applied to
the National Quality Forum (NQF)-endorsed QMs.

One approach involves exclusion of residents whose outcomes are not
under nursing facility control (e.g., outcome is evidenced on admission
to the facility) or the outcome may be unavoidable (e.g., the resident
has end-stage disease or is comatose). For each QM, the prevalence of
the outcome across all residents in a nursing facility, after
exclusions, is the *facility-level observed QM score*.

A second approach involves adjusting QM scores directly, using logistic
regression. This method of adjustment employs *resident-level
covariates* that have been found to increase the risks of an outcome.

-   First, resident-level covariates were used in a logistic regression
    model to calculate a *resident-level expected QM score* (the
    probability that the resident will evidence the outcome, given the
    presence or absence of characteristics measured by the covariates).

-   Then, an average of all resident-level expected QM scores for the
    nursing facility was calculated to create a *facility-level expected
    QM score*.

-   The final *facility-level adjusted QM score* was based on a
    calculation which combines the *facility-level expected score* and
    the *facility-level observed score*.

Refer to the original measure documentation for details.

#### STANDARD OF COMPARISON

External comparison at a point in time\
Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

The quality measures have been validated and are based on the best
research currently available. These quality measures meet four criteria.
They are important to consumers, are accurate (reliable, valid and risk
adjusted), can be used to show ways in which facilities are different
from one another, and can be influenced by the provision of high quality
care by nursing home staff. A formal validation study was conducted
involving 5,758 chronic and post-acute residents in 209 nursing
facilities in six states.

#### EVIDENCE FOR RELIABILITY/VALIDITY TESTING

Abt Associates, Inc, U.S. Department of Health and Human Services,
Centers for Medicare & Medicaid Services. Validation of long-term and
post-acute care quality indicators. Cambridge (MA): Abt Associates,
Inc.; 2003 Jun 10. 93 p.

### Identifying Information

#### ORIGINAL TITLE

Percent of residents whose ability to move about in and around their
room got worse.

#### MEASURE COLLECTION

[Nursing Home Quality Initiative: National Nursing Home Quality
Measures](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=11&doc=4200)

#### MEASURE SET NAME

[Chronic Care Quality
Measures](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=11&doc=4220)

#### DEVELOPER

Centers for Medicare & Medicaid Services

#### FUNDING SOURCE(S)

United States (U.S.) Government

#### COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

United States (U.S.) Government Staff, Clinical Experts, Researchers,
and Statisticians

#### FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

No conflicts of interest exist.

#### ENDORSER

National Quality Forum

#### INCLUDED IN

National Healthcare Disparities Report (NHDR)\
National Healthcare Quality Report (NHQR)\
Nursing Home Compare

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2004 Jan

#### REVISION DATE

2004 Nov

#### MEASURE STATUS

This is the current release of the measure.

This measure updates a previous version: Abt Associates, Inc, U.S.
Department of Health and Human Services, Centers for Medicare & Medicaid
Services. National nursing home quality measures. User\'s manual.
Cambridge (MA): Abt Associates, Inc.; 2004 Jan 1 (v1). 46 p.

#### SOURCE(S)

U.S. Department of Health and Human Services, Centers for Medicare &
Medicaid Services. National nursing home quality measures. User\'s
manual. Cambridge (MA): Abt Associates, Inc.; 2004 Nov (v1.2). 48 p.

#### MEASURE AVAILABILITY

The individual measure, \"Percent of residents whose ability to move
about in and around their room got worse,\" is published in \"National
Nursing Home Quality Measures. User\'s Manual.\" This document is
available in Portable Document Format (PDF) from the [Centers for
Medicare & Medicaid Services (CMS) Web
site](http://www.cms.hhs.gov/NursingHomeQualityInits/downloads/NHQIQMUsersManual.pdf).

For more information, refer to the CMS Web site at,
[www.cms.hhs.gov](http://www.cms.hhs.gov/).

#### COMPANION DOCUMENTS

The following is available:

-   Nursing Home Compare. \[internet\]. Baltimore (MD): Centers for
    Medicare & Medicaid Services. 2000- \[updated 2008 Jan 16\]; \[cited
    2008 May 22\]. This tool is available from the [Medicare Web
    site](http://www.medicare.gov/Nhcompare/Home.asp). See the related
    [QualityTools](http://www.innovations.ahrq.gov/content.aspx?id=1450)
    summary.

-   Quality measures for long-stay residents. Baltimore (MD): Centers
    for Medicare & Medicaid Services; 2004 Nov. 16 p. This document is
    available in Portable Document Format (PDF) from the [Centers for
    Medicare & Medicaid Services (CMS) Web
    site](http://www.cms.hhs.gov/NursingHomeQualityInits/downloads/NHQINHCconsumerlang.pdf).

#### NQMC STATUS

The NQMC summary was completed by ECRI on July 22, 2004. The information
was verified by the measure developer on August 30, 2004. This NQMC
summary was updated by ECRI on November 28, 2005. The information was
verified by the measure developer on February 8, 2006. The information
was verified again by the Colorado Foundation for Medical Care, under
contract with CMS on October 17, 2007.

#### COPYRIGHT STATEMENT

No copyright restrictions apply.

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008