Quality Indicators: Original CHSRA QIs

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QI Domains & Descriptions

Below is a list of quality indicators (QIs) defined by items in the MDS 2.0 2-page quarterly without Section U, by domain, along with brief descriptions. Please see the QI Definitions for the exact descriptions.

Accidents
Behavioral / Emotional Patterns
Clinical Management
Cognitive Patterns
Elimination / Incontinence
Infection Control
Nutrition / Eating
Physical Functioning
Psychotropic Drug Use
Quality of Life
Skin Care

Accidents

Incidence of New Fracture

Residents who have a hip fracture or other fracture on the most recent assessment. The denominator is the number of residents who did not have a hip fracture or other fracture on the previous assessment. This QI is not risk adjusted.

Prevalence of Falls

Residents who had falls on the most recent assessment. This QI is not risk adjusted and the denominator is all residents on the most recent assessment.

Behavioral / Emotional Patterns

Prevalence of Behavioral Symptoms Affecting Others

Residents who have displayed any type of problem behavior toward others on the most recent assessment. Behavioral symptoms include verbal abuse, physical abuse, or socially inappropriate/disruptive behavior.

This QI is RISK ADJUSTED. Residents are considered more likely (are at HIGH RISK) to exhibit behavior symptoms if they are cognitively impaired or have any psychotic disorders. Residents who do not have any of these conditions are considered LOW RISK. The denominator for the QI is all residents on most recent assessment.

Prevalence of Symptoms of Depression

Residents with symptoms of depression on the most recent assessment. This is a complex definition. Residents are considered to have this QI if they have a sad mood and have 2 or more symptoms of functional depression (defined below).

The symptoms of functional depression that are used in deciding whether a person meets one of these criteria also are complex. There are five symptoms, and some of those involve more than one item. These symptoms occurring within the most recent assessment period are: (1) negative statements; (2) agitation or withdrawal or resists care; (3) waking with an unpleasant mood, or not being awake most of the day and not comatose; (4) being suicidal or having recurrent thoughts of death; and (5) weight loss. This QI is not risk adjusted and the denominator is all residents on the most recent assessment.

Prevalence of Depression Without Antidepressant Therapy

Residents with symptoms of depression and no antidepressant therapy on the most recent assessment. Symptoms of depression are defined using the same criteria described above and no antidepressant therapy was provided. This QI is not risk adjusted and the denominator is all residents on the most recent assessment.

Clinical Management

Use of 9 or More Different Medications

Residents who received 9 or more different medications on the most recent assessment. This QI is not risk adjusted and the denominator is all residents on the most recent assessment.

Cognitive Patterns

Incidence of Cognitive Impairment

This QI measures the incidence of cognitive impairment between the most recent and previous assessments. It identifies those residents who were not cognitively impaired on the previous assessment, but who are cognitively impaired on their most recent assessment. Cognitive impairment is defined as having impaired decision making abilities and impaired short term memory problems. The denominator is only residents who were not cognitively impaired on the previous assessment. This QI is not risk adjusted.

Elimination / Incontinence

Prevalence of Bladder or Bowel Incontinence

Residents who were incontinent or frequently incontinent of either bladder or bowel on the most recent assessment. The denominator for this QI excludes residents who were comatose or had indwelling catheters or ostomies at the most recent assessment.

This QI is RISK ADJUSTED. Residents are considered more likely to be incontinent if they have a severe cognitive impairment or are totally dependent (self performance) in mobility ADLs (bed mobility, transfer, and locomotion). These residents are at HIGH RISK for incontinence. Those residents who do not have these conditions are considered LOW RISK.

Prevalence of Occasional or Frequent Bladder or Bowel Incontinence Without a Toileting Plan

This QI focuses on those residents who are incontinent, either occasionally or frequently, and who do not have a toileting plan noted on the most recent assessment. The denominator is residents with frequent or occasional incontinence in either bladder or bowel on the most recent assessment. This QI is not risk adjusted.

Prevalence of Indwelling Catheters

These are residents who were noted to have an indwelling catheter on their most recent assessment. The denominator is all residents on most recent assessment. This QI is not risk adjusted.

Prevalence of Fecal Impaction

Residents who have been noted with a fecal impaction on their most recent assessment. This QI is considered to be a sentinel health event, meaning that even if one person flags on this QI, it is of such a serious nature, that it should be investigated. This QI is not risk adjusted and the denominator is all residents on the most recent assessment.

Infection Control

Prevalence of Urinary Tract Infections

Residents identified on the most recent assessment as having had a urinary tract infection. This QI is not risk adjusted and the denominator is all residents on the most recent assessment.

Nutrition / Eating

Prevalence of Weight Loss

Residents noted with a weight loss (5% or more in 30 days or 10% or more in last 6 months) on the most recent assessment. This QI is not risk adjusted and the denominator is all residents on the most recent assessment.

Prevalence of Tube Feeding

Residents noted to have feeding tubes on the most recent assessment. This QI is not risk adjusted and the denominator is all residents on the most recent assessment.

Prevalence of Dehydration

Residents who have been either coded with the condition of dehydration (MDS check box) or with a diagnosis of dehydration (MDS ICD-9 CM 276.5). This QI is not risk adjusted and the denominator is all residents on most recent assessment.

Physical Functioning

Prevalence of Bedfast Residents

Residents who have been determined to be bedfast on the most recent assessment. This QI is not risk adjusted and the denominator is all residents on the most recent assessment.

Incidence of Decline in Late Loss ADLs

This QI measures decline in ADL functioning (self performance) over two assessment periods—the most recent and the assessment prior to that. Late loss ADLs are those which are considered the "last" to deteriorate—i.e., bed mobility, transferring, eating, and toileting. Over the assessment periods, there has been at least one level decline in two or more of these ADLs or there has been at least two levels of decline in one or more of them. In other words, the resident has experienced a gradual decline in two or more areas or a rather significant decline in one.

The denominator does not include residents who already were determined to be totally dependent or comatose on the previous assessment. This QI is not risk adjusted.

Incidence of Decline in ROM

Residents with increased functional limitation in Range of Motion (ROM) between previous and most recent assessment.

This QI is not RISK ADJUSTED. This QI includes only residents with the previous and most recent assessments on file with the exclusion of residents with maximal loss of ROM on the previous assessment.

Pyschotropic Drug Use

Prevalence of Antipsychotic Use in the Absence of Psychotic and Related Conditions

This QI identifies those residents who are receiving antipsychotics on the most recent assessment. The denominator for this QI excludes those residents with psychotic disorders, schizophrenia, Tourette's, Huntington's or those with hallucinations.

This QI is RISK ADJUSTED. Residents who exhibit both cognitive impairment and behavior problems at the most recent assessment are considered at HIGH RISK to receive antipsychotic medication. All others are considered at LOW RISK.

Prevalence of Antianxiety/Hypnotic Drug Use

Residents who received antianxiety medications or hypnotics on the most recent assessment. The denominator for this QI excludes those residents with psychotic disorders, schizophrenia, Tourette's, Huntington's or those with hallucinations. This QI is not risk adjusted.

Prevalence of Hypnotic Use More Than Two Times in the Last Week

Residents who received hypnotics more than twice in the last week on the most recent assessment. This QI is not risk adjusted and the denominator is all residents on the most recent assessment.

Quality of Life

Prevalence of Daily Physical Restraints

Residents who were restrained (trunk, limb, or chair) on a daily basis on the most recent assessment. This QI is not risk adjusted and the denominator is all residents on the most recent assessment.

Prevalence of Little or No Activity

Residents who, on the most recent assessment, were noted with little or no activity. The denominator includes all residents except those who are comatose. This QI is not risk adjusted.

Skin Care

Prevalence of Stage 1-4 Pressure Ulcers

Residents who have been assessed with any stage pressure ulcer(s) Stage 1-4 on the most recent assessment. Pressure ulcers can be identified on the MDS either by a checkbox or an ICD-9 707.0 code. The denominator is all residents on most recent assessment.

This QI is RISK ADJUSTED. Residents are considered to be at HIGH RISK for the development of pressure ulcers if they have any one or more of the following conditions: they are impaired for bed mobility or transfer; or are comatose; or are malnourished; or have an end stage disease on the most recent assessment. All other residents are considered to be at LOW RISK. Residents at low risk that flag should be investigated since this would be considered a sentinel event.