Quality control in nursing homes

Jean Chouinard's [1] comment that nursing home "quality of care should be measured . . . on an ongoing basis" deserves applause. However, to characterize the Miminimum Data Set (MDS) as a good first step hardly describes the benefit realized by Ontario's system-wide implementation of the instrument in chronic care hospitals. It is now possible to benchmark hospital performance on at least 24 valid and reliable indicators of the process and outcome of care. [2] In an Ottawa hospital study, Maxwell and colleagues [3] showed how the MDS addresses problems such as falls, incontinence, restraints and common infections.

To suggest that the MDS "fails to link defined outcomes to specific processes of care" confuses questions of measurement with questions of analysis. Using Chouinard's example of the need to assess skin care and nutritional support as predictors of pressure sores, one can find 9 items devoted to skin care and 15 dealing with nutritional status that can be related in longitudinal analyses to 14 items on pressure ulcers and skin condition in the MDS. The data are clearly there. One need only take the time to do the analysis to answer Chouinard's question.

The call for standardized assessment to address the needs of older people is more than a decade old. Now we hear a chorus of voices rising to say that quality of care in nursing homes must be evaluated on a systematic basis. The MDS is the best available tool to address these questions and more. Canadian long-term care facilities could continue to gaze into the distant future in search of a perfect system that will win the unanimous applause of all people interested in health care for the elderly. However, that day may never come. The MDS is here today, and it represents a giant leap forward from where we were yesterday.

John P. Hirdes, PhD

Department of Health Studies and Gerontology; University of Waterloo; Waterloo, Ont.

Competing interests: Dr. Hirdes is a member of the Board of Directors of interRAI, which owns the international copyright for the MDS series of instruments.