Here come the outcomes - utilizing computer database for nursing home treatments and outcomes

Nursing Homes, March, 1996 by David Patterson

Computers are great tools for collecting and analyzing data. A few strokes on a keyboard, a click of a mouse button, as wipe with a bar-code scanner, and information is both transportable and shareable in ways most of us couldn't even imagine a decade ago. Today, using computers, it is possible to quantify and compare nursing home treatments and outcomes from Asheville to Zanesville, to see who's doing what best, and how others might improve (all the while protecting patient privacy and proprietary business information).

And managed care will love it.

That's why efforts are afoot, both large and small. Biggest of all, of course, is the Health Care Financing Administration's plan for statewide quality assurance systems, based on MDS data, and scheduled to take effect in 1998 (if the Federal budget gods allow). Also large is the Medical Outcomes System developed by Chicago-based Formations in Health Care (a Medirisk subsidiary), involving 125 facilities providing subacute care.

Every month during the past few months these facilities have pooled their patient care data and transmitted them to Formations; the Formations staff has in turn analyzed them, put them into easily understandable numerical ratings and, just recently, transmitted back to each facility a quarterly report comparing its performance against the overall database. Patient conditions that were analyzed included comorbidity (the presence of multiple illnesses), pain, wound care needs and respiratory interventions. (Nutrition and infection control are coming up later this year.) In short, 125 facilities just "got a handle" on how well they stack up nationwide in key areas of subacute care.

Meanwhile, a long-term care software vendor has begun its own small pilot project compiling outcomes information for its nursing home customers. Health Outcomes Management, Inc. (formerly Data Med Clinical Support Services) has begin developing a shared database for nursing home users of its Assurance Long-Term Care System 2001 software. Ten facilities are involved thus far in building what the company is calling the outcome management database for long-Term Care.

The database downloads participating nursing homes' raw data on residents' health status, care plans, and outcomes, without naming the patients. No additional input of data is required at the nursing facility and there are no fees for taking part. Those data then will be analyzed by trained Health Outcomes Management staff and the comparative results reported to participants. If at some time in the future this service can be sold, 70% of the proceeds will go to the participant -- a sort of early illustration of how outcomes management (lower case) can be a moneymaking Health Outcomes Management (the company) expects to issue its first reports and to boost nursing home participation in the second half of this year.

Bill Peter, President of Health Outcomes Management, notes that his company has for years had software in place in nursing homes that were collecting data on treatment and cost, but that these data were internal to each facility. They weren't being centralized for shared analysis, even though this was technologically feasible. Peter figured that his company was a logical place to start such an effort. He adds that his database could be used right now to collect and analyze data from just about all the nursing home management software on the market -- but he doubts that will happen. This vendor market is highly competitive, and it is more likely that other long-term care software companies will develop their own shared database alternatives.

If so-and there's every indication that long-term care outcomes are a "hot topic," as managed care's interest grow -- nursing facilities can look forward to a whole series of new tools to help them analyze their performance compared to the overall market. The result should be a very interesting competition around the question. who provides the best care at the least cost? That would be some game -- but you need a computer to play. If you don't know how or don't want to, you could have a long, cold day on the bench.

David Patterson has been a regular contributor to Nursing Homes on long-term care computers and software.