Elderly/Long-Term Care

The Web-based Nursing Home Compare report card improves nursing home quality, but not across the board

The Centers for Medicare and Medicaid Services (CMS) published the first Nursing Home Compare Web-based report card in November of 2002. These report cards grade nursing homes on various dimensions of care, which consumers can consider in their selection of nursing homes. This should provide incentives to nursing homes to improve the quality of care they provide. However, a new study of a national sample of nursing homes found that the Nursing Home Compare report card was associated with improvement in some, but not all, of the five quality measures studied. 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, note Dana B. Mukamel, Ph.D., of the University of California, Irvine and William D. Spector, Ph.D., of the Agency for Healthcare Research and Quality.

Drs. Spector, Mukamel, and coinvestigators merged data from the Minimum Data Set, which provides information for nursing home residents with survey data for 701 nursing homes. These data allowed them to examine changes in outcome-based quality measures, comparing the period before and after publication of the report card, in relation to 20 specific actions undertaken by these nursing homes in response to publication of the report card. Two of the five Nursing Home Compare published quality measure scores-percentage of residents who are physically restrained daily, and percentage of residents who suffer moderate pain daily or excruciating pain ever-declined by about 10 percent, a noticeable improvement.

The percentage of residents with pressure ulcers and the percentage of residents who lost the ability to carry out activities of daily living or developed new infections showed no similar changes following publishing of the report card. The authors note that 1 year may not provide sufficient lead time for demonstrable change. The fact that not all actions led to improvement may reflect lack of knowledge among nursing homes as to what actions might be most effective. This suggests that publication of quality report cards should be accompanied by educational efforts to help nursing homes identify the best ways to improve care.

See "Publication of quality report cards and trends in reported quality measures in nursing homes," by Dana B. Mukamel, Ph.D., David L. Weimer, Ph.D., William Spector, Ph.D., Heather Ladd, and Jacqueline Zinn, Ph.D., in the August 2008 HSR: Health Services Research 43(4), pp. 1244-1262. Reprints (AHRQ Publication No. 09-R014) are available from the AHRQ Publications Clearinghouse.

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