Elderly/Long-Term Care

Public reporting of nursing home care improves care delivery

Quality of care information is being made increasingly public to aid consumers in choosing health care providers. At the same time, publicly released information encourages providers to improve the care they deliver to the community. For example, in 2002, the Centers for Medicare & Medicaid Services launched a public Web site called Nursing Home Compare, where consumers could evaluate skilled nursing facilities based on quality of care data made public. The Web site improved both unreported and reported care in skilled nursing facilities, according to a new study.

The researchers looked at nursing home data from 1999 to 2005 related to all postacute care admissions. Three measures of quality were reported on the Nursing Home Compare Web site: pain, delirium, and walking ability. All three quality measures improved after the Web site was launched. The percentage of patients with controlled pain improved by 2.6 percent. The improvement was 0.5 percent for patients not suffering from delirium. Ability of residents to walk improved by 0.4 percentage points. Unreported measures also improved, including such things as reduced pain, better locomotion, less shortness of breath, and less bladder incontinence. In general, skilled nursing facilities scoring high on reported quality measures also demonstrated improvement on unreported measures. Similarly, those nursing homes scoring low on reported measures had significantly smaller improvements or had worsening scores on unreported measures after the Web site was made available to the public.

Despite a national decline in professional nurse (registered nurses and licensed practical nurses)-staff ratios, high-scoring nursing homes had consistently smaller declines in professional nurse hours per resident day than low-scoring nursing homes. The study was supported in part by the Agency for Healthcare Research and Quality (HS16478).

See "Impact of public reporting on unreported quality of care," by Rachel M. Werner, M.D., Ph.D., R. Tamara Konetzka, Ph.D., and Gregory B. Kruse, M.Sc., M.P.H., in the April 2009 HSR: Health Services Research 44(2), pp. 379-398.

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