Making nursing home quality reports public leads to improved posthospitalization care

Patient Safety and Quality
Making nursing home quality reports public leads to improved posthospitalization care

Public reports on the quality of care are one way to motivate health care institutions to strive for excellence. For example, the Nursing Home Compare Web site, launched in 2002, publicly rates the performance of nursing homes on certain quality measures. The launch of this Web site was associated with improvement in two of the three postacute (posthospitalization) care performance measures: no pain and improved walking. However, it was not linked to fewer potentially preventable reshospitalizations, a broader measure of nursing home postacute care quality, reveals a new study.

Rachel M. Werner, M.D., Ph.D., of the University of Pennsylvania, and colleagues used national data collected between 1999 and 2005 on every resident in Medicare- and Medicaid-certified nursing homes. They also used information from Medicare part A claims to determine the number of potential hospital readmissions that could have been prevented. Their analysis was limited to the quality of postacute care rather than long-term care. They compared these quality measures both before the launch of the Nursing Home Compare Web site and after and controlled for secular trends in quality using nursing homes not included in public reporting. The Web site contains reports on 10 quality measures from more than 17,000 nursing homes. The study included information on 8,137 nursing homes and nearly 1 million postacute care stays.

Two of the three postacute quality measures were better in the 3 years after the public reporting system was launched than before. The number of patients without moderate-to-severe pain improved 0.6 percent. There was also a 0.7 percent improvement in the number of patients with improved walking, but no change in the number of patients without delirium. There was also no significant improvement observed in the rate of preventable rehospitalizations.

The researchers recommend combining public reporting with pay-for-performance incentives to drive even stronger improvements in quality. Their study was supported in part by the Agency for Healthcare Research and Quality (HS16478).

See "Impact of public reporting on quality of postacute care," by Dr. Werner, R. Tamara Konetzka, Ph.D., Elizabeth A. Stuart, Ph.D., and others, in HSR: Health Services Research 44(4), pp. 1169-1187, 2009.