[Federal Register Volume 69, Number 88 (Thursday, May 6, 2004)]
[Notices]
[Pages 25392-25394]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-10284]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality


Request for Measures of Family Assessment of Nursing Home Care

AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS.

ACTION: Notice of request for measures.

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SUMMARY: The Agency for Healthcare Research and Quality (AHRQ) is 
soliciting a voluntary submission by researchers, survey firms, 
stakeholders and other interested parties of survey instruments, or 
items from survey instruments, measuring family assessments of nursing 
home care. The Centers for Medicare & Medicaid Services (CMS) 
established as a priority, support for the development of a 
standardized survey for measuring and publicly reporting family and 
residents' assessments of nursing home care that could be used nation 
wide, and asked AHRQ for assistance in the development and testing of 
the survey instruments. A resident survey has been developed that is 
the process of field testing. The next step is the development of a 
standardized instrument for investigation of family perspectives on 
residents' nursing home care. As part of the feasibility study, AHRQ is 
reviewing existing instruments that capture family members' assessments 
of resident's nursing home care. To conduct as inclusive a review as 
possible of successful or informative measures of care, the agency is 
requesting voluntary submission of such instruments or individual 
measures along with documentation for administration of the instruments 
or individual measures, and, if possible, critical evaluations of 
particular measures or related survey administration techniques. If 
selected for incorporation into a standardized CAHPS instrument for 
comparing family assessments of nursing home care, measure(s) will be 
made freely available to encourage their widespread use and the 
creation of uniform criteria by which nursing homes can be compared by 
consumers and other interested individuals and organizations. The final 
instrument will carry a CAHPS trademark to assure that if it is 
distributed or implemented as a CAHPS instrument, it will be used in 
accordance with CAHPS instructions and documentation. It should be 
noted that though the term ``family'' is used throughout, the term 
should be construed broadly to include all persons who periodically 
observe the care of a nursing home resident (e.g., a ``significant 
other'') and, based on their contact, are able to provide the 
perspective and assessment of a concerned third party regarding the 
resident's care received in the nursing home.

DATES: Please submit instruments and supporting information on or 
before July 6, 2004, to Judith Sangl (see address below). AHRQ will 
inquire and determine whether each submitter wishes to be identified. 
Submitters will not respond individually to submitters, but will 
consider all submitted instruments and measures and publicly report the 
results of the review of the submissions in aggregate. Prior to 
releasing the names of submitters we will inquire and determine whether 
each submitter wishes to be identified. Submitters will not be 
identified with specific items in the final instrument.

ADDRESSES: Submissions should include a brief cover letter, a copy of 
the instrument or items for consideration and supporting information as 
specified under ``Submission Criteria'', below. Submissions may be in 
the form of a letter or e-mail, preferably with an electronic file in a 
standard word processing format on a 3\1/2\-inch floppy disk or as an 
e-mail attachment. Electronic submissions are encouraged. Please do not 
use any acronyms. Responses to this request should be submitted to: 
Judith Sangl, Agency for Healthcare Research and Quality, 540 Gaither 
Road, Rockville, MD 20850, Phone: (301) 427-1308, Fax: (301) 427-1341, 
E-mail: [email protected],
    To facilitate handling of submissions, please include full 
information about the instrument developer or contact: (a) Name, (b) 
title, (c) organization, (d)

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mailing address, (e) telephone number, (f) fax number, and (g) e-mail 
address. Also, please submit a copy of the instrument or items to be 
considered. A copy or citation of relevant peer-reviewed journal 
articles is also desirable, but not required. For citations, please 
include the title of the article, author(s), publication year, journal 
name, volume, issue, and page numbers where the article appears and/or 
other applicable evidence.
    All submissions must include a statement of willingness to grant to 
AHRQ the right to use and authorize others to use submitted measures 
and their documentation as part of a CAHPS[reg]-trademarked instrument. 
This statement must be signed by an individual authorized to act for 
any holder of copyright on the measure(s) or instrument(s). Authority 
of signator should be indicated or included. Submitters' willingness to 
grant to AHRQ the right to use and authorize others to use their 
measures or instruments means that there can be free access to all 
measures in the CAHPS[reg] instrument, and free access to the 
instrument's supportive/administrative information. It is the agency's 
intention that the CAHPS[reg] instrument for nursing home resident's 
family member assessment of nursing home care will be made publicly 
available, free of charge.

FOR FURTHER INFORMATION CONTACT: Judith Sangl, from the Center for 
Quality Improvement and Patient Safety, Agency for Healthcare Research 
and Quality, (please see contact information above).

Submission Criteria

    Instruments submitted should be usable to measure a family member's 
assessment of a short- or a long-term stay of a nursing home resident, 
whichever is applicable.
    Measures submitted must:
    1. Capture the resident's family member's assessment of care in a 
short/and or long-stay nursing home setting; and,
    2. Demonstrate a high degree of reliability and validity.
    AHRQ, in collaboration with highly experienced CAHPS investigators, 
will evaluate all submitted measures and instruments and select one 
instrument or more likely, measures from various instruments, either in 
whole or in part, for testing and, if required or appropriate, 
additional modification. AHRQ will assume responsibility for the final 
measures set as well as any future modifications to its family 
assessment of nursing home care instrument. The CAHPS[reg] trademark 
will be applied to the new instrument which will incorporate and 
combine the best features of all the submissions as well as any ideas 
that may develop from reviewing them, and any future modifications to 
the instrument. As a matter of quality control, there will be warnings 
that the CAHPS[reg] identification may not be used if any changes are 
made to the instrument or final measures or if survey administration 
deviates from the prescribed methods without review and permission of 
the Agency.
    Each submission should include the following information:
     The name of the instrument;
     domain(s);
     language(s) the instrument is available in;
     evidence of cultural/cross group comparability, if any;
     cognitive screening or assessments used;
     selection of most appropriate family member/significant 
other, if more than one available;
     instrument reliability (internal consistency, test-retest, 
etc.);
     validity (content, construct, criterion-related);
     response rates;
     cost estimates for data collection;
     methods and results of cognitive testing and field-
testing; and,
     description of sampling strategies and data collection 
protocols, including such elements as mode of administration, informed 
consent materials, use of advance letters, timing and frequencies of 
contacts.
    In addition, a list of nursing homes in which the instrument has 
been fielded or counts of the number of nursing homes by state or 
region, in which the survey has been and/or is being used should also 
be included in the submission materials. Measures that have been tested 
or implemented in just one or two research studies or nursing home 
settings would have more limited value than those tested or implemented 
more widely, but would be considered on a more individual basis when 
evaluating the measure for further testing with regard to their 
inclusion in the CAHPS tool.
    Submission of copies of existing report formats developed to 
disclose findings to consumers and providers is desirable, but not 
required. Additionally, information about existing database(s) for the 
instrument(s) submitted is helpful, but not required for submission. 
Evidence of meeting the validity, reliability, and other criteria may 
be demonstrated through submission of peer-reviewed journal article(s) 
or through the best evidence available at the time of submission.

SUPPLEMENTARY INFORMATION:

Background

    AHRQ is a leader in developing and testing instruments for 
measuring consumer experience within the healthcare system of the 
United States as evidenced by the development of CAHPS[reg], 
formerly the Consumer Assessment of Health Plans, which provides 
information on health plan quality to consumers and purchasers alike. 
While CAHPS[reg] is highly regarded within the industry and 
provides valuable information; it does not address family member 
perspectives on resident care within nursing home settings. 
Standardization of measures is essential for meaningful comparison of 
performance across nursing homes and other providers. Use of a 
standardized measure of family member assessment of nursing home 
settings provides several benefits including: Comparable information 
across nursing homes for the public about the quality of care from the 
family's perspective; data-based recommendations for quality 
improvement efforts and a data base to stimulate research in this area.
    Family members are often the primary decision-makers with regard to 
nursing home placement and selection. They may also serve in the role 
of resident advocate after nursing home placement has occurred. Hence, 
the National Quality Forum (NQF) has cited the need for measures of 
resident and family satisfaction as a high priority for inclusion in 
the nursing home measure set. NQF specifically cited the need for rapid 
development of a freely available and accessible standardized 
instrument.
    In an effort to address the concerns of the industry, the Centers 
for Medicare & Medicaid Services (CMS) established a priority to 
examine the feasibility of a standard instrument or measurement for 
public reporting of family assessments (broadly defined) of nursing 
home residents' care. Accordingly, AHRQ, through a collaborative 
process with CMS and other stakeholders, has initiated the process for 
this project. The steps to advance this initiative include:
     Stakeholder Meetings: Public meetings will be held to 
identify the issues and concerns of interested stakeholders in the 
healthcare community. Summaries of all meetings will be posted on the 
AHRQ Web site (www.ahrq.gov).
     Survey Development and Testing: The process by which 
measures will be defined and the most useful instruments or measures 
identified is as follows: Instruments submitted will be evaluated by 
the CAHPS team of experts in consultation with AHRQ staff to

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determine if they meet high priority or common measurement needs and to 
identify whether additional measure development is required. Until the 
trademarked version is available, access to and use of draft versions 
will be limited and subject to certain conditions, e.g., obtaining 
explicit written permission from AHRQ and in return, agreeing to 
provide assessments of testing experience with the measures.
     Implementation Plan: A description of the final survey 
process as well as recommendations to implement the final standardized 
CAHPS[reg] family assessment of nursing home care instrument 
will be made readily available e.g., on AHRQ and CMS Web sites and will 
include information related to data collection, analysis, and public 
reporting.

    Dated: April 26, 2004.
Carolyn M. Clancy,
Director.
[FR Doc. 04-10284 Filed 5-5-04; 8:45 am]
BILLING CODE 4160-90-M