Evidence supporting the use of public reporting of quality information to improve health care quality is mixed. While public reporting may improve reported quality, its effect on quality of care more broadly is uncertain. This study tests whether public reporting in the setting of nursing homes resulted in improvement of reported and broader but unreported quality of postacute care.
1999-2005 nursing home Minimum Data Set and inpatient Medicare claims.
We examined changes in postacute care quality in U.S. nursing homes in response to the initiation of public reporting on the Centers for Medicare and Medicaid Services website, Nursing Home Compare. We used small nursing homes that were not subject to public reporting as a contemporaneous control and also controlled for patient selection into nursing homes. Postacute care quality was measured using three publicly reported clinical quality measures and 30-day potentially preventable rehospitalization rates, an unreported measure of quality.
Reported quality of postacute care improved after the initiation of public reporting for two of the three reported quality measures used in Nursing Home Compare. However, rates of potentially preventable rehospitalization did not significantly improve and, in some cases, worsened.
Public reporting of nursing home quality was associated with an improvement in most postacute care performance measures but not in the broader measure of rehospitalization.
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"Even though the possibility of gaming of the data in response to the performance evaluation cannot be excluded, previous studies did not find evidence of gaming . Some studies have reported that changes in data accuracy may partially explain quality improvement . However, we did not find relevant changes in recording of co-morbidities in our study population over the years (data not shown). "
[Show abstract][Hide abstract] ABSTRACT: P.Re.Val.E. is the most comprehensive comparative evaluation program of healthcare outcomes in Lazio, an Italian region, and the first Italian study to make health provider performance data available to the public. The aim of this study is to describe the P.Re.Val.E. and the impact of releasing performance data to the public.
P.Re.Val.E. included 54 outcome/process indicators encompassing many different clinical areas. Crude and adjusted rates were estimated for the 2006-2009 period. Multivariate regression models and direct standardization procedures were used to control for potential confounding due to individual characteristics. Variable life-adjusted display charts were developed, and 2008-2009 results were compared with those from 2006-2007.
Results of 54 outcome indicators were published online at http://www.epidemiologia.lazio.it/prevale10/index.php. Public disclosure of the indicators' results caused mixed reactions but finally promoted discussion and refinement of some indicators. Based on the P.Re.Val.E. experience, the Italian National Agency for Regional Health Services has launched a National Outcome Program aimed at systematically comparing outcomes in hospitals and local health units in Italy.
P.Re.Val.E. highlighted aspects of patient care that merit further investigation and monitoring to improve healthcare services and equity.
BMC Health Services Research 01/2012; 12(1):25. DOI:10.1186/1472-6963-12-25 · 1.71 Impact Factor
"Most of the research documenting poor nursing home quality has been among the long-stay population (Institute of Medicine 2001). To the extent previous research has found an effect of Nursing Home Compare, it has largely been among the short-stay quality measures (e.g., Werner et al. 2009b). Given that Medicare residents are associated with higher profit margins relative to Medicaid residents (Medicare Payment Advisory Commission 2005; Troyer 2002), the greater responsiveness to the short-stay quality report card measures is not surprising. "
[Show abstract][Hide abstract] ABSTRACT: We evaluate the effects of the Nursing Home Quality Initiative (NHQI), which introduced quality measures to the Centers for Medicare and Medicaid Services' Nursing Home Compare website, on facility performance and consumer demand for services.
The nursing home Minimum Data Set facility reports from 1999 to 2005 merged with facility-level data from the On-Line Survey, Certification, and Reporting System.
We rely on the staggered rollout of the report cards across pilot and nonpilot states to examine the effect of report cards on market share and quality of care. We also exploit differences in nursing home market competition at baseline to identify the impacts of the new information on nursing home quality.
The introduction of the NHQI was generally unrelated to facility quality and consumer demand. However, nursing homes facing greater competition improved their quality more than facilities in less competitive markets.
The lack of competition in many nursing home markets may help to explain why the NHQI report card effort had a minimal effect on nursing home quality. With the introduction of market-based reforms such as report cards, this result suggests policy makers must also consider market structure in efforts to improve nursing home performance.
Health Services Research 07/2011; 46(6pt1):1698-719. DOI:10.1111/j.1475-6773.2011.01298.x · 2.78 Impact Factor
"These studies have found that report card scores improved on some clinical measures but not others (Mukamel et al. 2008b; Werner et al. 2009). For measures where quality scores improved, such as the proportion of nursing home residents with pain, the size of the improvement was modest (Werner et al. 2009). "
[Show abstract][Hide abstract] ABSTRACT: To test whether public reporting in the setting of postacute care in nursing homes results in changes in patient sorting.
All postacute care admissions from 2001 to 2003 in the nursing home Minimum Data Set.
We test changes in patient sorting (or the changes in the illness severity of patients going to high- versus low-scoring facilities) when public reporting was initiated in nursing homes in 2002. We test for changes in sorting with respect to pain, delirium, and walking and then examine the potential roles of cream skimming and downcoding in changes in patient sorting. We use a difference-in-differences framework, taking advantage of the variation in the launch of public reporting in pilot and nonpilot states, to control for underlying trends in patient sorting.
There was a significant change in patient sorting with respect to pain after public reporting was initiated, with high-risk patients being more likely to go to high-scoring facilities and low-risk patients more likely to go to low-scoring facilities. There was also an overall decrease in patient risk of pain with the launch of public reporting, which may be consistent with changes in documentation of pain levels (or downcoding). There was no significant change in sorting for delirium or walking.
Public reporting of nursing home quality improves matching of high-risk patients to high-quality facilities. However, efforts should be made to reduce the incentives for downcoding by nursing facilities.
Health Services Research 11/2010; 46(2):555-71. DOI:10.1111/j.1475-6773.2010.01205.x · 2.78 Impact Factor