The Development of Person-Centered
Care Criteria and Measurement Tools:
Process and Content of a
Multidisciplinary Enterprise
AHCA Quality Symposium
San Antonio, TX
February 18, 2011
Michael Lepore, PhD
Director of Quality, Research, & Evaluation
Planetree
mlepore@planetree.org
&
Investigator in Community Health
Brown University
michael_lepore@brown.edu
Collaborators
Planetree
• Heidi Gil
• Susan
Frampton,
PhD
• Christy
Davies
• Affiliate sites
Brown
University
My
InnerView
IDEAS
Institute
• Susan Miller,
PhD
• Michael
Lepore, PhD
• Vivian TellisNayak, PhD
• Mary TellisNayak
• Maggie
Calkins,
PhD
• Jennifer
Brush
Research Support

The Commonwealth Fund
◦ Developing Systems to Support Person-Centered Care:
Optimizing Planetree’s Continuing Care Designation
Criteria and Measurement Strategies
A note on language
For the purpose of this presentation, the terms
person-centered care and person-centeredness
are used, though other terms also are recognized
(patient-centered, resident-centered, family-centered,
relationship-centered, etc.)
Outline

Person-centered care (PCC) criteria and measures
◦ Why develop PCC criteria and measures?
◦ How were PCC criteria and measures developed?
◦ What are the PCC criteria and measures?
◦ How can we use the PCC criteria and measures?
Why develop PCC
criteria and measures?
Why develop PCC criteria and measures?

The Institute of Medicine identified PCC as a
healthcare priority

What is person-centered care?
◦ “health care that establishes a partnership among
practitioners, patients, and their families (when
appropriate) to ensure that decisions respect patients
wants, needs, and preferences and that patients have the
education and support they require to make decisions and
participate in their own care.” (IOM, 2001, Envisioning a
National Healthcare Quality Agenda)
Why develop PCC
criteria and measures?

PCC is a complex
concept requiring
multiple dimensions
of culture change
MJ Koren (2010). PersonCentered Care For Nursing
Home Residents: The
Culture-Change Movement.
Health Affairs, 29: 312-317
Homelike
atmosphere
Resident
direction
Close
relationships
PCC
Qualityimprovement
processes
Staff
empowerment
Collaborative
decision
making
Why develop PCC criteria and measures?

Benchmark performance internally / longitudinally

Benchmark performance externally / in comparison
to competitors

Understand relationship between PCC and other
factors (e.g., financial, regulatory performance)
Why develop PCC criteria and measures?

Long-term care executives call for new measures
◦ “I think measurement is key. We have to develop new
measurements if we want new outcomes. And people
pay attention to what we’re measuring, and many of
the current measurements are still good, but we need
additional measurements.”
 Long-Term Care Improvement Guide
(available for free download at www.planetree.org)
How were PCC criteria
and measures developed?
How were PCC criteria developed?
Step 1
Step 2
Step 3
• Preliminary criteria developed through focus
groups and expert committee from Planetree,
My InnerView, IHI, Joint Commission, etc
• Preliminary criteria crosswalked with PCC
measurement tools & literature (evidence base)
• Recommendations made for revision (e.g., drop,
add, merge, split)
• Criteria revisions reviewed by research team &
representatives from affiliated LTC sites
• Consensus on criteria established
Original
A plan for caring touch is developed and
implemented as appropriate. (Exceptions include
behavioral health patients.) Examples of caring
touch include massage, healing touch, therapeutic
touch and Reiki.
Related
Measurement
or Literature
CAHPS Resident Surveys:
What number would you use to rate how gentle
the nursing home staff were when they helped
you?
Revised
…Beyond implementation of formal caring touch
programs, patients’/residents’ daily care is
provided with gentleness.
Multi-Method Evaluation Protocol
Self
Assessment
Focus
Groups
Quality
Profile (QP)
Satisfaction
Survey
How were PCC measures developed?
Step 1
• Preliminary Quality Profile measures suggested
based on review of existing satisfaction and PCC
measurement tools and literature
Step 2
• Providers interviewed about measurement needs
and surveyed about feasibility and importance of
preliminary measures
Step 3
• Measures reviewed by research team &
representatives from affiliated provider sites
• Consensus reached on Quality Profile measures
Originally
% of residents who did not die alone (some one
Recommended was within 10 feet some time during the last
Measure
hour) during the month
Response from
Providers
Revised
Measure
Nursing home
Importance
2.25
Feasibility
3.57
Assisted living
3
1
(Not at all)
(Very)
1-----------------------------------------------------5
% of residents who died in place (not transferred
to the hospital in the 7 days prior to death)
What are the PCC
criteria and measures?
What are the PCC criteria?
Criterion
3
Eleven core
Components
each with
specific criteria
Criterion
2
Component
Criterion
1
Planetree Components of Person-Centered Care
Component I. Structures &
Functions Necessary for
Implementation,
Development & Maintenance
of Resident-Centered
Concepts & Practices
Component V. Nutrition Program
Component II. Human
Interactions / Independence
Dignity & Choice
Component VIII. Spirituality &
Diversity
Component III. Resident
Choice & Responsibility
Component IV. Family
Involvement
Component VI. Healing
Environment: Architecture & Design
Component VII. Arts Program /
Meaningful Activities / Entertainment
Component IX. Integrative
Therapies / Paths to Well-Being
Component X. Healthy
Communities / Enhancement of Life's
Journey
Component XI. Measurement
What are the PCC criteria?
A multi-disciplinary
task force oversees
resident-centered
practices
Residentcentered care
coordinator is
designated
I. Structures
& Functions
Resident, family
& staff focus
groups are
conducted
periodically
What are the PCC criteria?
A comprehensive
presentation on PCC
concepts, practices &
initiatives is provided
for all new staff &
residents as a part of
orientation
Staff have the
opportunity for
personalizing care
in partnership
with each resident
II. Human
Interactions
Numerous
opportunities are
provided for staff
celebration,
reward &
recognition
What are the PCC criteria?
Residents are
provided with
meaningful
discharge/
transition
instructions
A process is in place
for sharing clinical
information, including
the medical record &
care plan, with
residents
III. Resident
Choice &
Responsibility
A process is in
place to fully
disclose &
apologize for
unanticipated
outcomes to
residents
What are the PCC criteria?
A process
aligned with each
resident’s
preferences is in
place to contact
family to
communicate
progress
Partner with
families in all
aspects of
residents’
care
IV. Family
Involvement
Flexible, 24hour,
residentdirected
visiting
hours
What are the PCC criteria?
24-hour access
to a variety of
foods &
beverages
Fresh, healthy food
at appropriate
temperatures, & a
variety of food
choices
V. Nutrition
Program
Residents have
opportunities to
participate in
meal planning
What are the PCC measures?

Quality Profile (QP) includes quantitative metrics
for evaluating an organization’s performance with
regard to important elements of PCC as
identified in the literature and from providers
◦ QP to be completed on last Friday of month
What are the PCC measures?

The measures, like the criteria, are designed to
teach and to motivate, not merely to avoid
lapses in quality
◦ They beckon affiliates to rise up to the challenge and
to reach for excellence
◦ Some measures relate to specific criteria, and some
are more global (e.g., relating to org. health)
A multi-disciplinary task force is established to
oversee and assist with implementation and
maintenance of patient-/resident-centered
practices, which includes a mix of nonsupervisory and management staff, including a
Criterion
combination of clinical and non-clinical staff, and
meets regularly (every 4-6 weeks) on an ongoing
basis. In continuing care environments, this task
force also includes residents and family
members.
Measure
Numerator: Cumulative meetings this year
Denominator: Data month (1-12)
Processes are in place for evaluating, identifying
and effectively integrating into the care plan
what is important to each resident, based on
Criterion his/her identity, decision-making ability, and
mastery skills, and what is meaningful to that
resident in the living environment and in daily
activities.
Measure
% of care plans completed in which the resident
participated
A model of care delivery or work design is
adopted that embraces continuity, consistency
and accountability-based care, and allows staff
Criterion
the opportunity and responsibility for
personalizing care in partnership with each
patient/resident.
Measure
% of care plans completed in which a CNA
participated
A comprehensive formalized approach for
partnering with families in all aspects of the
patient’s/ resident’s care, and tailored to the
Criterion
needs and abilities of the organization and its
facility, is developed. An example is a Care
Partner Program.
Measure
% of care plans in which families participated
Residents are given an opportunity to
participate, as appropriate, in a retreat
experience or an equivalent to assist with
Criterion internalizing resident-centered care concepts
and to enhance sensitivity to the needs of the
entire community. Resident retreats are
conducted at a minimum annually.
Measure
% of residents that have completed the retreat
Criterion
A flexible transportation system is
provided that enables residents to satisfy
personal wishes, to participate in off-site
activities and to volunteer.
Measure
% of residents (who are not unable to leave
site due, for instance, to health)
participating in off-site activities promoting
personal growth, such as volunteering,
political or religious activities, arts and
leisure, etc
Criterion
Leadership includes approaches that motivate
and inspire others, promote positive morale,
mentor and enhance performance of others,
recognize the knowledge and decision-making
authority of others and model organizational
values.
Measure
% of supervisors that are specifically trained to
mentor on the person-centered approach.
Criterion
All staff, including off-shift, part-time, prn,
providers and support staff are given an
opportunity to participate in a minimum of
eight hours of patient-/resident-centered staff
retreat experiences or an equivalent, with a
minimum concurrent completion rate of 85%.
Measure
% of staff that have completed the retreat
Criterion
Continuing education to reinforce and
revitalize staff engagement in patient/resident-centered behaviors and practices
and build competence around the
community’s evolving needs is offered on an
ongoing basis to all staff in meaningful ways
determined by the organization.
Numerator:
Measure
# of staff who have been
participated in advanced
training opportunities
Denominator: Total # of staff
Residents’ wellness needs are approached
holistically. Examples include the provision of
wellness programs, such as nutrition counseling
and stress management and implementation of
(or access to) programs that support residents in
Criterion
chronic disease management. Residents have
convenient access to physical and mental fitness
opportunities, as well as to podiatry, vision,
hearing, and dental services, and psychological
and pharmaceutical consultation.
Measure
% of residents that participated in one or more
organized wellness activities
Additional PCC measures

Measures broadly related to PCC,
but not tied to specific criteria
Concept
Measure
Staff
Empowerment
% of new employee interviews in which line
staff participate (dietary, housekeeping,
CNA)
Resident
Empowerment
% of CNA hiring decisions made in which a
resident participated
Resident Health % of residents that participated in one or
& Wellness
more organized wellness activities
Concept
Measure
End of Life
Care
% of residents with advance care wishes
documented
End of Life
Care
% of residents who died in place (not
transferred to hospital in the 7 days prior to
death)
Emotional
Support
Services
# of events for residents that specifically and
primarily address topics of loss (e.g., loss of
mobility/driving, vision or hearing; grief
management; mental status changes;
incontinence)
Concept
Measures
% of nursing shifts (RN, LPN, CNA) covered by
agency staff
% of staff consistently assigned to the same
residents (Advancing Excellence measure)
Consistent
Care
Turnover of staff
•Voluntary
•Involuntary
Absenteeism: %of nursing staff who did not
report to work as scheduled
Concept(s)
Measure
Organizational
Stability
Tenure of DON(s)
Organizational
Stability
Tenure of Administrator(s)
Organizational
Stability &
Consistent
Care
Tenure of nursing staff (average months of
service of all nursing staff)
Concept
Measure
Organizational
Health
Occupancy rate (Census): % of
units/apartments that are occupied
Organizational
Health
# of vacant positions
Organizational
Health
# of staff injuries
Summary

Person-centered care criteria established
through review of literature and provider
experiences and views

Multi-method system for evaluating personcentered care established

Quantitative instrument for measuring
person-centered care established
Next Steps

Identify sites to formally pilot measures
◦ Provide sites data collection measurement guides
(e.g., worksheets for measures)
◦ Provide sites mentoring in data use

Test measurement instrument
◦ Validity, Reliability, Harmonization/Transportability
For guidance in achieving
person-centered care,
the Long Term Care
Improvement Guide is
available for free
download at
http://www.planetree.org
Questions:
mlepore@planetree.org