CHSRA researchers are known for the development of the original Quality Indicator (QI) reporting system which the Center for Medicare and Medicaid Services (CMS) released to states in July 1999. This QI reporting system was developed by CHSRA under a subcontract that was part of a general contract with CMS. The QIs developed by CHSRA researchers are markers that indicate either the presence or absence of potentially poor nursing home care practices or outcomes. QIs represent the first known systematic attempt to longitudinally record the clinical and psychosocial profile of nursing home residents in a standardized, relatively inexpensive and regular manner requiring the expertise of only in-house staff. In 2005 CMS extended the state reporting system to make use of a new set of Quality Indicators/Quality Measures (QI/QMs). The new QI/QMs are based on the original CHSRA QIs with a new numbering system, a new way of adjusting for risk factors for 3 of the QI/QMs and the inclusion of a pain measure and 3 new Post Acute Care (PAC) QI/QMs.