Quality-of-life Assessment
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…BUT ANALYSES SHOW THAT SOME QUESTIONS TOP OTHERS
What do we make of these results? Satisfaction with care is subjective; so when a resident tells us that overall, she is satisfied with the amount of walking assistance she receives but would like more of it, we are obliged to accept both statements. (And no, our analyses show that this response pattern is not related to a resident's cognitive status.) That said, given our goal of collecting information useful for improvement efforts and given what we know of acquiescence, reduced expectations, and fear of reprisals among nursing home residents, it is appropriate to question the questions. How effective is each type? Findings from our studies show the following (4,7):
- The proportion of residents reporting unmet needs for ADL care are significantly higher with the discrepancy and open-ended questions compared to the direct satisfaction questions. This suggests that the former questions are more sensitive to differences in satisfaction levels and that the latter questions are more limited by acquiescent response biases.
- Open-ended questions produce the most useful information for individualizing aspects of technical care and assessing the interpersonal quality of care.
- Discrepancy questions elicit specific information useful for changing the frequency or occurrence of ADL care; and, these questions are most sensitive to care quality improvements.
- Direct satisfaction questions are the least useful for designing improvement interventions and the most unreliable (when residents were re-interviewed within a day or two of their first interview, they were most likely to change their answers to questions of this type).
In sum, the direct satisfaction questions-commonly used in nursing home surveys-proved the least useful and reliable. The discrepancy and open-ended questions are better choices for quality improvement purposes.
In the next section, Interview Protocol, we present a quality-of-life assessment protocol that takes into account these findings as well as the mandate, born of research, not regulations, to interview residents as the best reporters of their quality of life. You can use this protocol to develop and implement an effective assessment strategy for your facility.
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