AMDA Nursing Home Measures Endorsed By NQF

Columbia, MD–Oct. 18, 2012 — In October 2012, the National Quality Forum (NQF) Neurology Steering Committee recommended two nursing home measures submitted by AMDA be considered for endorsement.

AMDA developed the two quality measures, titled Persistent Indicators of Dementia without a Diagnosis-Long Stay and Persistent Indicators of Dementia without a Diagnosis-Short Stay, as part of its ongoing commitment to improve care for persons with dementia in nursing homes and to harmonize with existing Centers for Medicare & Medicaid Services (CMS) measures.

Several elements of the CMS Minimum Data Set (MDS 3.0) capture and incorporate important information about a patient’s symptoms, including mental status (BIMS), depression (PHQ-9) and delirium (CAM) for the measures.

Up to 70% of nursing home patients carry a diagnosis of dementia; however, many health professionals believe that the disease remains under-diagnosed. Unrecognized dementia leads to poorly coordinated care, to the overuse of aggressive care, and to inappropriate and non-compassionate care for patients with the life-limiting illness.

“Dementia in long term care is a rising epidemic, much of it undiagnosed and undetected,” says Dr. James Lett, CMD, one of the measure developers. “The co-morbidity of dementia increases care costs, raises the rate of thirty-day re-admissions to hospitals, and elicits an ethical dilemma we could not conceive of when we all entered the practice of medicine.”

“Endorsement of the AMDA dementia measures will help drive long term care to detect and address dementia earlier,” says Lett.

Early and accurate diagnosis is vital to optimizing care planning and to long term outcomes for persons with dementia and their families. These proposed quality measures encourage recognition, comprehensive assessment and appropriate treatment of cognitive decline to generate several benefits.

Since cognitive decline can have multiple etiologies, recognition of the problem can lead to identification of reversible or treatable medical or psychological conditions. Proper diagnosis of dementia can help in the development of a comprehensive care plan that includes not only appropriate treatment, but also education of staff and family members about the disease and its prognosis.

“This is the essence of patient-centered care, and will serve our residents and society well,” says Lett. “Nothing could be a better legacy for AMDA and our mission.”

A patient’s comprehensive care plan would focus on restoration and stabilization of intellectual function, which might include discontinuation of medications known to worsen intellectual function and addresses neuropsychiatric symptoms that complicate dementia. Appropriate care of these symptoms is necessary to optimize patients' function and quality of life. 

Dr. Eric Tangalos, CMD, also a developer of the measures, says, “What could be better than going into a nursing home, seeing a severely demented patient and being able to make a diagnosis of Alzheimer’s disease? With these new measures and with each new diagnosis, there is so much to be gained.”

The next step for these measures is the 30-day comment period for NQF members and the public, which will start around October 31.  The measures will be brought to the Consensus Standards Approval Committee (CSAC) in early February.  The CSAC makes recommendations to the Board, and it is expected that the board’s decision and the final endorsement of the measure will be set in late February.  NQF will then have a 30-day appeals period in which anyone can appeal any endorsed measure.  

The “Health Policy Advisor” section of AMDA’s website will provide future updates on the endorsement process.