Study Identifies Quality Indicators Focused on Role of Primary Care Providers

October 15, 2018

Many, if not most, existing quality measures for nursing home care reflect facility processes and characteristics, which are not designed to evaluate the primary care provider’s (PCP) role in this setting. A new study in the October issue of JAMDA identifies quality indicators (QIs) that could be used to assess the quality of care provided by PCPs in nursing homes.

In “Quality Indicators of Primary Care Provider Engagement in Nursing Home Care,” the authors describe a project intended, for the first time, to identify specific, valid process measures of care quality, or QIs, that account for the unique patient population and care environment in post-acute and long-term care (PALTC). The project identified QIs in which PCP engagement adds value through expertise in:

  • Recognizing geriatric syndromes
  • Employing evidence-based PALTC practice
  • Advocating for PALTC residents and patients
  • Delivering person-centered care
  • Facilitating advance care planning
  • Communicating effectively to coordinate care and to manage care transitions

The final set included 97 QIs rated “valid and feasible” and 8 rated “valid but not feasible.”

The panel used AMDA – the Society for Post-Acute and Long-Term Care Medicine’s Attending Physician Competencies to help identify appropriate PCP-related QIs for this setting. These describe the baseline skills and knowledge that a nursing home PCP should possess to practice competently. The study authors used the AMDA Competencies to help identify the steps of care that are influenced by a competent PCP and would lead to better outcomes if implemented.

The authors concluded, “This project creates much-needed performance measures that can be used to assess care quality and that can inform interventions to improve the health-related quality of life of nursing home residents.” They suggested that the QIs might also serve as a clinical teaching tool for trainees or providers new to PALTC, noting, “These QIs could illuminate the relationship between PCP engagement and better resident outcomes.”

This study was conducted by researchers at Cedars-Sinai Medical Center (Section of Geriatrics, Division of General Internal Medicine, Department of Medicine), Los Angeles, CA; UCLA/Jewish Home Borun Center for Gerontological Research, University of California, Los Angeles, CA; The RAND Corporation, Santa Monica, CA; Baycrest Health Sciences, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, The Netherlands; and Department of Geriatrics, College of Medicine, Florida State University, Tallahassee, FL.

Click here for more information on the findings above and more details about the study. To contact the researchers or JAMDA editor for an interview, please email



JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.

About the Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.