Omissions of Care in Nursing Homes: A Uniform Definition for Research and Quality Improvement |
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| Affiliation: | 1. American Institutes for Research, Washington, DC, USA;2. American Health Care Association, Washington, DC, USA;3. Brown University, Providence, RI, USA;4. Agency for Healthcare Research and Quality, Rockville, MD, USA;1. Medicus Economics, Milton, MA, USA;2. Takeda Pharmaceuticals, Deerfield, IL, USA;3. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA;4. Parkinson''s Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA;1. Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, CO, USA;2. Veterans Health Administration, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, CO, USA;3. New Courtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA;4. Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA;1. Division of Geriatric and Palliative Medicine, Alpert School of Medicine, Brown University, 593 Eddy Street, Providence, RI 02903, USA;2. Division of Geriatric Medicine and Gerontology, Department of Family Medicine, University of California, Irvine, 101 The City Drive, Orange, CA 92868, USA;1. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Hôpital Broca, Service de gériatrie, F-75013, Paris, France;2. EA 4468, Université de Paris, F-75013, Paris, France;3. Centre Hospitalier Sainte-Anne, GHU Paris Psychiatrie & Neurosciences, F-75014, Paris, France;4. Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Service de gériatrie, F-94804, Villejuif, France;5. Université Paris-Sud XI, F-94270, Le Kremlin-Bicêtre, France;6. Fondation de recherche sur l''hypertension artérielle (FRHTA), F-75013, Paris, France;7. Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpêtrière, Sorbonne Université, F-75013, Paris, France |
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| Abstract: | Omission of care in US nursing homes can lead to increased risk for harm or adverse outcomes, decreased quality of life for residents, and increased healthcare expenditures. However, scholars and policymakers in long-term care have taken varying approaches to defining omissions of care, which makes efforts to prevent them challenging. Subject matter experts and a broad range of nursing home stakeholders participated in iterative rounds of engagement to identify key concepts and aspects of omissions of care and develop a consensus-based definition that is clear, meaningful, and actionable for nursing homes. The resulting definition is “Omissions of care in nursing homes encompass situations when care—either clinical or nonclinical—is not provided for a resident and results in additional monitoring or intervention or increases the risk of an undesirable or adverse physical, emotional, or psychosocial outcome for the resident.” This concise definition is grounded in goal-concordant, resident-centered care, and can be used for a variety quality improvement purposes and for research. |
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| Keywords: | Medical errors care left undone health care rationing missed care unmet need |
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