Developing and measuring practice-based quality indicators of physicians in nursing homes

The COVID-19 pandemic shows the threat to older adults, especially residents living in nursing homes. Residents living in nursing homes are impacted by the care practices delivered by their physicians in these homes. Care practices of physicians includes all admission and annual assessments, monitoring and disease management as health changes, routine medical care, and medication management. Little is known about the quality of the practice delivered by physicians and this needs to be measured. Physicians themselves do not believe that pre-existing measures reflect physician quality, as they often reflect the resident-level outcomes instead. By measuring practice-based quality indicators, this research will evaluate the quality of practice delivered, assess the role of physicians, identify performance gaps, and direct quality improvement initiatives. The aims of my doctoral research are to (a) measure the quality of practice of physicians in nursing homes based on accepted standards and (b) examine the associations between the quality indicators and resident-important outcomes such as the use of antipsychotics, transfer to the emergency department, admission to hospital, and death. This research will uniquely use electronic medical record (PointClickCare) data from 120 nursing homes, which includes resident information. This data repository is the first of its kind in Canada and is a new way of using electronic medical record data to measure quality. The findings of this research will be used to give individual physicians feedback on their performance, set benchmarks for sector-wide performance, and create a tool to monitor and track physician quality of practice. Further, this research will inform policy with recommendations on how to best use health resources in nursing homes including implications for publicly funded care.