[Federal Register: May 6, 2004 (Volume 69, Number 88)]
[Notices]
[Page 25392-25394]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr06my04-55]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
Request for Measures of Family Assessment of Nursing Home Care
AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS.
ACTION: Notice of request for measures.
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SUMMARY: The Agency for Healthcare Research and Quality (AHRQ) is
soliciting a voluntary submission by researchers, survey firms,
stakeholders and other interested parties of survey instruments, or
items from survey instruments, measuring family assessments of nursing
home care. The Centers for Medicare & Medicaid Services (CMS)
established as a priority, support for the development of a
standardized survey for measuring and publicly reporting family and
residents' assessments of nursing home care that could be used nation
wide, and asked AHRQ for assistance in the development and testing of
the survey instruments. A resident survey has been developed that is
the process of field testing. The next step is the development of a
standardized instrument for investigation of family perspectives on
residents' nursing home care. As part of the feasibility study, AHRQ is
reviewing existing instruments that capture family members' assessments
of resident's nursing home care. To conduct as inclusive a review as
possible of successful or informative measures of care, the agency is
requesting voluntary submission of such instruments or individual
measures along with documentation for administration of the instruments
or individual measures, and, if possible, critical evaluations of
particular measures or related survey administration techniques. If
selected for incorporation into a standardized CAHPS instrument for
comparing family assessments of nursing home care, measure(s) will be
made freely available to encourage their widespread use and the
creation of uniform criteria by which nursing homes can be compared by
consumers and other interested individuals and organizations. The final
instrument will carry a CAHPS trademark to assure that if it is
distributed or implemented as a CAHPS instrument, it will be used in
accordance with CAHPS instructions and documentation. It should be
noted that though the term ``family'' is used throughout, the term
should be construed broadly to include all persons who periodically
observe the care of a nursing home resident (e.g., a ``significant
other'') and, based on their contact, are able to provide the
perspective and assessment of a concerned third party regarding the
resident's care received in the nursing home.
DATES: Please submit instruments and supporting information on or
before July 6, 2004, to Judith Sangl (see address below). AHRQ will
inquire and determine whether each submitter wishes to be identified.
Submitters will not respond individually to submitters, but will
consider all submitted instruments and measures and publicly report the
results of the review of the submissions in aggregate. Prior to
releasing the names of submitters we will inquire and determine whether
each submitter wishes to be identified. Submitters will not be
identified with specific items in the final instrument.
ADDRESSES: Submissions should include a brief cover letter, a copy of
the instrument or items for consideration and supporting information as
specified under ``Submission Criteria'', below. Submissions may be in
the form of a letter or e-mail, preferably with an electronic file in a
standard word processing format on a 3\1/2\-inch floppy disk or as an
e-mail attachment. Electronic submissions are encouraged. Please do not
use any acronyms. Responses to this request should be submitted to:
Judith Sangl, Agency for Healthcare Research and Quality, 540 Gaither
Road, Rockville, MD 20850, Phone: (301) 427-1308, Fax: (301) 427-1341,
E-mail: jsangl@ahrq.gov,
To facilitate handling of submissions, please include full
information about the instrument developer or contact: (a) Name, (b)
title, (c) organization, (d)
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mailing address, (e) telephone number, (f) fax number, and (g) e-mail
address. Also, please submit a copy of the instrument or items to be
considered. A copy or citation of relevant peer-reviewed journal
articles is also desirable, but not required. For citations, please
include the title of the article, author(s), publication year, journal
name, volume, issue, and page numbers where the article appears and/or
other applicable evidence.
All submissions must include a statement of willingness to grant to
AHRQ the right to use and authorize others to use submitted measures
and their documentation as part of a CAHPS[reg]-trademarked instrument.
This statement must be signed by an individual authorized to act for
any holder of copyright on the measure(s) or instrument(s). Authority
of signator should be indicated or included. Submitters' willingness to
grant to AHRQ the right to use and authorize others to use their
measures or instruments means that there can be free access to all
measures in the CAHPS[reg] instrument, and free access to the
instrument's supportive/administrative information. It is the agency's
intention that the CAHPS[reg] instrument for nursing home resident's
family member assessment of nursing home care will be made publicly
available, free of charge.
FOR FURTHER INFORMATION CONTACT: Judith Sangl, from the Center for
Quality Improvement and Patient Safety, Agency for Healthcare Research
and Quality, (please see contact information above).
Submission Criteria
Instruments submitted should be usable to measure a family member's
assessment of a short- or a long-term stay of a nursing home resident,
whichever is applicable.
Measures submitted must:
1. Capture the resident's family member's assessment of care in a
short/and or long-stay nursing home setting; and,
2. Demonstrate a high degree of reliability and validity.
AHRQ, in collaboration with highly experienced CAHPS investigators,
will evaluate all submitted measures and instruments and select one
instrument or more likely, measures from various instruments, either in
whole or in part, for testing and, if required or appropriate,
additional modification. AHRQ will assume responsibility for the final
measures set as well as any future modifications to its family
assessment of nursing home care instrument. The CAHPS[reg] trademark
will be applied to the new instrument which will incorporate and
combine the best features of all the submissions as well as any ideas
that may develop from reviewing them, and any future modifications to
the instrument. As a matter of quality control, there will be warnings
that the CAHPS[reg] identification may not be used if any changes are
made to the instrument or final measures or if survey administration
deviates from the prescribed methods without review and permission of
the Agency.
Each submission should include the following information:
The name of the instrument;
domain(s);
language(s) the instrument is available in;
evidence of cultural/cross group comparability, if any;
cognitive screening or assessments used;
selection of most appropriate family member/significant
other, if more than one available;
instrument reliability (internal consistency, test-retest,
etc.);
validity (content, construct, criterion-related);
response rates;
cost estimates for data collection;
methods and results of cognitive testing and field-
testing; and,
description of sampling strategies and data collection
protocols, including such elements as mode of administration, informed
consent materials, use of advance letters, timing and frequencies of
contacts.
In addition, a list of nursing homes in which the instrument has
been fielded or counts of the number of nursing homes by state or
region, in which the survey has been and/or is being used should also
be included in the submission materials. Measures that have been tested
or implemented in just one or two research studies or nursing home
settings would have more limited value than those tested or implemented
more widely, but would be considered on a more individual basis when
evaluating the measure for further testing with regard to their
inclusion in the CAHPS tool.
Submission of copies of existing report formats developed to
disclose findings to consumers and providers is desirable, but not
required. Additionally, information about existing database(s) for the
instrument(s) submitted is helpful, but not required for submission.
Evidence of meeting the validity, reliability, and other criteria may
be demonstrated through submission of peer-reviewed journal article(s)
or through the best evidence available at the time of submission.
SUPPLEMENTARY INFORMATION:
Background
AHRQ is a leader in developing and testing instruments for
measuring consumer experience within the healthcare system of the
United States as evidenced by the development of CAHPS[reg],
formerly the Consumer Assessment of Health Plans, which provides
information on health plan quality to consumers and purchasers alike.
While CAHPS[reg] is highly regarded within the industry and
provides valuable information; it does not address family member
perspectives on resident care within nursing home settings.
Standardization of measures is essential for meaningful comparison of
performance across nursing homes and other providers. Use of a
standardized measure of family member assessment of nursing home
settings provides several benefits including: Comparable information
across nursing homes for the public about the quality of care from the
family's perspective; data-based recommendations for quality
improvement efforts and a data base to stimulate research in this area.
Family members are often the primary decision-makers with regard to
nursing home placement and selection. They may also serve in the role
of resident advocate after nursing home placement has occurred. Hence,
the National Quality Forum (NQF) has cited the need for measures of
resident and family satisfaction as a high priority for inclusion in
the nursing home measure set. NQF specifically cited the need for rapid
development of a freely available and accessible standardized
instrument.
In an effort to address the concerns of the industry, the Centers
for Medicare & Medicaid Services (CMS) established a priority to
examine the feasibility of a standard instrument or measurement for
public reporting of family assessments (broadly defined) of nursing
home residents' care. Accordingly, AHRQ, through a collaborative
process with CMS and other stakeholders, has initiated the process for
this project. The steps to advance this initiative include:
Stakeholder Meetings: Public meetings will be held to
identify the issues and concerns of interested stakeholders in the
healthcare community. Summaries of all meetings will be posted on the
AHRQ Web site (http://www.ahrq.gov).
Survey Development and Testing: The process by which
measures will be defined and the most useful instruments or measures
identified is as follows: Instruments submitted will be evaluated by
the CAHPS team of experts in consultation with AHRQ staff to
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determine if they meet high priority or common measurement needs and to
identify whether additional measure development is required. Until the
trademarked version is available, access to and use of draft versions
will be limited and subject to certain conditions, e.g., obtaining
explicit written permission from AHRQ and in return, agreeing to
provide assessments of testing experience with the measures.
Implementation Plan: A description of the final survey
process as well as recommendations to implement the final standardized
CAHPS[reg] family assessment of nursing home care instrument
will be made readily available e.g., on AHRQ and CMS Web sites and will
include information related to data collection, analysis, and public
reporting.
Dated: April 26, 2004.
Carolyn M. Clancy,
Director.
[FR Doc. 04-10284 Filed 5-5-04; 8:45 am]
BILLING CODE 4160-90-M