Functional status outcomes for assessment of quality in long-term care

Objective. Although decline in functional status has been recommended as a quality indicator in long-term care, studies examining its use provide no c onsensus on which definition of functional status outcome is the most appro priate to use for quality assessment. We examined whether different definit ions of decline in functional status affect judgments oi quality of care pr ovided in Department of Veterans Affairs (Vh) long-term care facilities. Methods. Six measures of functional status outcome that are prominent in th e literature were considered. The sample consisted of 15409 individuals who resided in VA long-term care facilities at any time from 4/1/95 to 10/1/95 . Activities of daily living variables were used to generate measures of fu nctional status. Differences between residents' baseline and semi-annual as sessments were considered and facility performance using the various defini tions of functional status were described. Results. The percentage of residents seen as declining in functional status ranged from 7.7% to 31.5%, depending upon the definition applied. The defi nition of functional status also affected rankings, z-scores, and 'outlier' status for facilities. Conclusion, Judgments of facility performance are sensitive to how outcome measures are defined. Careful selection of an appropriate definition of fun ctional status outcome is needed when assessing quality in long-term care.