OneClinical Corner : Quality Measure Q&A

by Danielle Banman, OT, Therapy Resource

Who is included in the long-stay quality measures for decline in ADL and ambulation performance?

To be included in the denominator for these quality measures, the residents who have been with us for over 100 days cannot already be dependent in these areas, be comatose, or receiving hospice services.

How is decline in ADLs and ambulation determined for quality measures?

For ADL performance, a two-point decline in one of the four areas is assessed. The four areas are lying to sitting, sit to stand, eating, and toilet transfers. If a resident’s need for assistance increased from supervision to substantial for eating, the resident would trigger for a decline in ADL performance. If a resident’s need for assistance increased from partial assistance to substantial with toilet transfers and sit to stand, the resident would also trigger for a decline in ADL performance.

For ambulation, a one-point decline in the resident’s ability to ambulate 10 feet is assessed. If a resident’s need for assistance to ambulate 10 feet increases from partial to substantial, the resident would trigger for a decline.

What are some best practices for preventing decline with these quality measures?

• MDS, Therapy, and Nursing collaboration for scheduled assessments to determine if decline is predicted based on previous assessment scores

• Therapy evaluations to specifically assess ADL and ambulation decline and interventions to improve prior to MDS assessment

• Therapy to Nursing communication forms: information to care plan and Kardex