The quality of care provided in America’s long-term care facilities has long been a matter of national concern. Historically, most efforts to improve the quality of care have been regulatory or disciplinary in nature. Recently, however, quality improvement methods successfully used in other fields have taken hold in healthcare in general and in long-term care in particular. New data suggest that real improvement is occurring, although there is widespread agreement that much more needs to be done.
On July 16, 2002, the three major industry organizations pledged to improve the quality of care delivered by the nation’s long-term care facilities. Called Quality First, A Covenant for Healthy, Affordable, and Ethical Long Term Care, this 5-year voluntary initiative aims to achieve excellence in the quality of care and services for older persons, and strengthen public trust in care and service delivery.
From the federal government comes quality initiatives launched by the U.S. Department of Health and Human Services (HHS) in 2002. These initiatives, called the Nursing Home Quality Initiative (NHQI) and the Home Health Quality Initiative (HHQI), which enlisted the help of the National Quality Forum and other entities, includes a nursing home and home healthcare quality measurement and reporting system. The conceptual underpinnings of the NHQI and HHQI are straightforward—i.e., by reliably measuring quality and by making the results of measurement available to the public, providers will be motivated to improve quality, and both good and poor performers will be identifiable to the public.
The next step on the road to quality improvement is the National Commission for Quality Long-term Care, an autonomous body that will evaluate the quality of long-term care, identify factors influencing the ability to improve the quality of care, and make recommendations about national efforts that should lead to sustainable quality improvement.
General Scope and Terms of the Commission
The National Commission for Quality Long-term Cares purpose is to:Recommend national aims and goals for long-term care quality improvement, including specific objectives and targets for improving long-term care quality;Report on long-term care quality indicators and performance measures to determine progress in achieving national improvement aims and goals, and to judge the success of improvement efforts;Provide a forum for public dialogue among long-term care professionals, consumers, regulators, purchasers, providers and other stakeholders on long-term care quality and quality improvement;Review quality-related policy proposals, and facilitating accountability and public confidence in long-term care; andRecommend a national policy agenda for long-term care quality improvement.
Independence: To help ensure the independence and objectivity of the Commission, it is convened and overseen by the National Quality Forum, a private, not-for-profit healthcare quality improvement organization established in 1999. While the NQF provides managerial, staff and systems support for the Commission, the Commission is a functionally independent organization.
Membership: The Commission is composed of 14 members who reflect a diversity of experience, expertise and interests. The Commissioners are appointed by the NQF, in consultation with leaders and advocates from the long-term care community. Commission members have 3-year terms, except at the outset when the inaugural Commission members have 1-, 2- or 3-year terms, as determined by a random selection process. Commission members may be reappointed for a second term. Commission members are people of accomplishment and demonstrated high integrity; who have general knowledge of long-term care, quality improvement and related matters; or who by virtue of their training and experience would be likely to inspire public confidence. Commissioners serve without compensation, but are reimbursed for legitimate, documented Commission activity-related expenses.
Reports: The Commission reports at least annually on its findings and recommendations. This report is disseminated by the NQF. The Commission may promulgate additional statements, reports and other materials as appropriate.
Meetings: The Commission meets three times per year, at least twice in person. Meetings, generally held in Washington, DC, are open to the public, except during executive session. Additional meetings may be scheduled as needed to accomplish the purposes of the Commission.