Quality Report Cards and Nursing Home Quality (original) (raw)
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Health Services Research, 2008
Objective. To examine associations between nursing homes' quality and publication of the Nursing Home Compare quality report card. Data Sources/Study Settings. Primary and secondary data for 2001-2003: 701 survey responses of a random sample of nursing homes; the Minimum Data Set (MDS) with information about all residents in these facilities, and the Nursing Home Compare published quality measure (QM) scores. Study Design. Survey responses provided information on 20 specific actions taken by nursing homes in response to publication of the report card. MDS data were used to calculate five QMs for each quarter, covering a period before and following publication of the report. Statistical regression techniques were used to determine if trends in these QMs have changed following publication of the report card in relation to actions undertaken by nursing homes. Principal Findings. Two of the five QMs show improvement following publication. Several specific actions were associated with these improvements. Conclusions. Publication of the Nursing Home Compare report card was associated with improvement in some but not all reported dimensions of quality. This suggests that report cards may motivate providers to improve quality, but it also raises questions as to why it was not effective across the board.
Publication of Quality Report Cards and Trends in Reported Quality Measures in Nursing Homes
Health Services Research, 2008
Objective. To examine associations between nursing homes' quality and publication of the Nursing Home Compare quality report card. Data Sources/Study Settings. Primary and secondary data for 2001-2003: 701 survey responses of a random sample of nursing homes; the Minimum Data Set (MDS) with information about all residents in these facilities, and the Nursing Home Compare published quality measure (QM) scores. Study Design. Survey responses provided information on 20 specific actions taken by nursing homes in response to publication of the report card. MDS data were used to calculate five QMs for each quarter, covering a period before and following publication of the report. Statistical regression techniques were used to determine if trends in these QMs have changed following publication of the report card in relation to actions undertaken by nursing homes. Principal Findings. Two of the five QMs show improvement following publication. Several specific actions were associated with these improvements. Conclusions. Publication of the Nursing Home Compare report card was associated with improvement in some but not all reported dimensions of quality. This suggests that report cards may motivate providers to improve quality, but it also raises questions as to why it was not effective across the board.
Nursing homes' response to the nursing home compare report card
The Journals …, 2007
Objectives. The Centers for Medicare and Medicaid Services have recently begun publishing the Nursing Home Compare report card. The objective of this study was to examine the initial reactions of nursing homes to publication of the report card and to evaluate the impact of the report card on quality-improvement activities. Methods. We conducted a survey of a random national sample of 1,502 nursing home administrators; 724 responded. We analyzed frequency of responses to questions regarding views of the quality measures and actions taken. Results. A model of nursing homes' behavior predicted that the report card would provide an incentive for facilities to improve quality. A majority of facilities (69%) reported reviewing their quality scores regularly, and many have taken specific actions to improve quality. Homes with poor quality scores were more likely to take actions following the publication of the report card. Discussion. These findings suggest that the Nursing Home Compare report card has the potential to positively affect nursing home quality.
Designing a Report Card for Nursing Facilities: What Information Is Needed and Why
The Gerontologist, 2003
Purpose: This article presents a rationale and conceptual framework for making comprehensive consumer information about nursing facilities available. Such information can meet the needs of various stakeholder groups, including consumers, family/ friends, health professionals, providers, advocates, ombudsman, payers, and policy makers. Design and Methods: The rationale and framework are based on a research literature review of key quality indicators for nursing facilities. Results: The findings show six key areas for information: (a) facility characteristics and ownership; (b) resident characteristics; (c) staffing indicators; (d) clinical quality indicators; (e) deficiencies, complaints, and enforcement actions; and (f) financial indicators. This information can assist in selecting, monitoring, and contracting with nursing facilities. Implications: Model information systems can be designed using existing public information, but the information needs to be enhanced with improved data.
JMIR Research Protocols, 2021
Background In June 2018, the United States Department of Veterans Affairs (VA) began the public reporting of its 134 Community Living Centers’ (CLCs) overall quality by using a 5-star rating system based on data from the national quality measures captured in CLC Compare. Given the private sector’s positive experience with report cards, this is a seminal moment for stimulating measurable quality improvements in CLCs. However, the public reporting of CLC Compare data raises substantial and immediate implications for CLCs. The report cards, for example, facilitate comparisons between CLCs and community nursing homes in which CLCs generally fare worse. This may lead to staff anxiety and potentially unintended consequences. Additionally, CLC Compare is designed to spur improvement, yet the motivating aspects of the report cards are unknown. Understanding staff attitudes and early responses is a critical first step in building the capacity for public reporting to spur quality. Objective W...
The Quality of Quality Measurement in U.S. Nursing Homes
Purpose: This article examines various technical challenges inherent in the design, implementation, and dissemination of health care quality performance measures. Design and Methods: Using national and state-specific Minimum Data Set data from 1999, we examined sample size, measure stability, creation of ordinal ranks, and risk adjustment as applied to aggregated facility quality indicators. Results: Nursing home Quality Indicators now in use are multidimensional and quarterly estimates of incidence-based measures can be relatively unstable, suggesting the need for some averaging of measures over time. Implications: Current public reports benchmarking nursing homes' performances may require additional technical modifications to avoid compromising the fairness of comparisons.
The Gerontologist, 2005
Purpose: This study examines the relationship between the first set of quality measures (QMs) published by the Centers for Medicare and Medicaid Services on the Nursing Home Compare Web site and five nursing home structural characteristics: ownership, chain affiliation, size, occupancy, and hospital-based versus freestanding status. Design and Methods: Using robust linear regressions, we examined the values of the QMs at first publication and their change over the first five reporting periods, in relation to facility characteristics. Results: There were significant baseline differences associated with these facility characteristics. Pain, physical restraints, and delirium exhibit a clear downward trend, with differences between the first QM reporting period and the fifth ranging from 12.7% to 46.0%. However, there were only minimal differences in trends associated with facility characteristics. This suggests that the relative position of facilities on these measures did not change much within this time period. The variation by facility type was larger for the shortstay QMs than for the long-stay measures. Implications: Those QMs that show an improvement exhibit it across all types of facilities, irrespective of initial quality levels. Although a number of alternatives may explain this positive trend, the trend itself suggests that report cards, to the extent that they are effective, are so for all facility types but only some QMs.
Purpose: This article reports on a study to identify ''building blocks'' for quality report cards for geriatric care. Its aim is to present (a) the results of the study and (b) the innovative step-by-step approach that was developed to arrive at these results. Design and Methods: We used Concept Mapping/Structured Conceptualization to define the building blocks. Applied to this study, we carried out Concept Mapping using several data collection methods: (a) a Web search, (b) semistructured interviews, (c) document analysis, (d) questionnaires, and (e) focus groups. Results: The findings showed that, although home care and institutional care for elderly adults share many quality themes, experts need to develop separate quality report cards for the two types of geriatric care. Home care consumers attach more value to the availability, continuity, and reliability of care, whereas consumers of institutional care value privacy, respect, and autonomy most. This study also showed, unlike many other quality report card studies, that consumers want information on structure, process and outcome indicators, and rating outcome indicators such as effectiveness and safety of care both for home care and for institutional care. Concept Mapping proved to be a valuable method for developing quality report cards in health care. Implications: Building blocks were delivered for two quality report cards for geriatric care and will be used when quality report cards are built in The Nether-lands. For the U.S. context, this study shows that current national report cards for geriatric care should be supplemented with quality-of-life data.
Nursing home quality and financial performance: Is there a business case for quality?
Inquiry: The Journal of Health Care Organization, Provision, and Financing, 2019
This study examines the relationship between nursing home quality and financial performance to assess whether there is a business case for quality. Secondary data sources included the Online Survey Certification and Reporting (OSCAR), Certification and Survey Provider Enhanced Reporting (CASPER), Medicare Cost Reports, Minimum Data Set (MDS 2.0), Area Resource File (ARF), and LTCFocus for all free-standing, nongovernment nursing homes for 2000 to 2014. Data were analyzed using panel data linear regression with facility and year fixed effects. The dependent variable, financial performance, consisted of the operating margin. The independent variables comprised nursing home quality measures that capture the three dimensions of Donabedian's structure-process-outcomes framework: structure Registered Nurse (RN) hours per resident day, Licensed Practical Nurse (LPN) hours per resident day, Certified Nursing Assistant (CNA) hours per resident day, RN skill mix), process (facility-acquired restraints, facility-acquired catheters, pressure ulcer prevention, and restorative ambulation), and outcomes (facility-acquired contractures, facility-acquired pressure ulcers, hospitalizations per resident, rehospitalizations, and health deficiencies). Control variables included size, average acuity index, market competition, per capita income, and Medicare Advantage penetration rate. This study found that the operating margin was lower in nursing homes that reported higher LPN hours per resident day and higher RN skill mix (structure); higher use of catheters, lower pressure ulcer prevention, and lower restorative ambulation (process); and more residents with contractures, pressure ulcers, hospitalizations and health deficiencies (outcomes). The results suggest that there is a business case for quality, whereas nursing homes that have better processes and outcomes of care perform better financially. What do we already know about this topic? Weech-Maldonado and colleagues (2003) reported that nursing homes that had higher quality of care were able to lower resident costs contributing to superior financial performance; however, these studies were limited to a cross-sectional analysis of a limited state sample from 1996. How does your research contribute to the field? This study contributes to the literature by examining the relationship between nursing home financial performance (operating margin) and quality using a national longitudinal database (2000-2014) and an expanded set of structure, process, and outcome measures of quality. What are your research's implications toward theory, practice, or policy? Producing a high quality of care may allow nursing homes to become more efficient, or it may allow the nursing home to have higher revenues due to higher quality, which can ultimately improve financial performance.
Inter-rater reliability of nursing home quality indicators in the U.S
BMC Health Services Research, 2003
Background: In the US, Quality Indicators (QI's) profiling and comparing the performance of hospitals, health plans, nursing homes and physicians are routinely published for consumer review. We report the results of the largest study of inter-rater reliability done on nursing home assessments which generate the data used to derive publicly reported nursing home quality indicators.