Preference Congruence- Objective Indicator from the Abramson Center

Starting in 2012, a team of recreational therapists, researchers, information technology specialist and a quality improvement professional wanted to demonstrate the feasibility of developing a new objective quality indicator measure. There is growing consensus as to the desirability of providing care that is tailored to needs and preferences of frail elders; there remains a significant gap in measuring tailored care for quality improvement purposes in long term care communities. The quality improvement initiative embraced the development of a person-centered tool for evaluating the extent to which a facility’s recreational care addresses the choice, needs and preferences of their residents.   Additionally, this presented as a viable opportunity to demonstrate “Meaningful Use Requirements” that have emerged out of health care reform encouraging providers to make maximum use of electronic medical records.

Research was conducted to create a new quality indicator (QI) measure that allows providers to document and track their level of person-centered care in recreational activity delivery using EMR data.  This QI is constructed by assessing resident preferences using the Preferences for Everyday Living Inventory (PELI) and tracking monthly preferred activity attendance.  The reported indicator represents an objective measure of preference fulfillment for each resident.   In other words, if a resident indicated that a particular recreational preference was “very” or “somewhat” important to her, what percent of the time did the resident actually attend that activity in the course of one month. The objective quality indicator is advantageous for several reasons. In particular, its ability to leverage information for the entire SNF population.

Development of the objective quality indicator has promising potential to provide real-time data to the facility to expand their ability to meet QAPI regulations to “identify and correct quality deficiencies as well as sustain performance improvement” for the recreational and leisure pursuits for an individual resident, household and facility level. Reporting was formatted to help a facility to become proficient in developing root cause analysis for areas of targeted improvement.  


Future development is focused on the feasibility of replicating this work in a user-friendly format for use in a variety of long term care settings.