AHRQ Grant HS021861: Related Publication Summaries

Improving Consumer Response to Nursing Home Quality Information

1. "Quality improvement under nursing home compare: The association between changes in process and outcome measures."

Werner RM, Konetzka RT, Kim MM.
Medical Care 2013 Jul; 51(7):582-588.
PUBMED link: www.ncbi.nlm.nih.gov/pubmed/23756645

This study tested the extent to which improvements in outcomes of nursing home care are explained by changes in care processes. Of the 5 outcome measures examined in over 16,000 nursing homes, only improvements in the percentage of residents in moderate to severe pain were associated with changes in nursing home processes of care. This study reinforced previous studies suggesting that nursing homes are responding to public reports, but also reinforced studies showing a weak relationship between process and outcome measures in a variety of settings. The authors recommend developing process measures that are more closely tied to desired outcomes, as well as closer monitoring of incentive programs to ensure accurate, reliable measurement of quality.

2. "Changes in consumer demand following public reporting of summary quality ratings: an evaluation in nursing homes."

Werner RM, Konetzka RT, Polsky D.
Health Services Research 2016 Jun;51 Suppl 2:1291-309.
PUBMED link:

The study’s objective was to evaluate consumer response to summary measures in the setting of nursing homes. It found that the star rating system was associated with a significant change in consumer demand for low- and high-scoring facilities. After the star-based rating system was released, 1-star facilities typically lost 8 percent of their market share and 5-star facilities gained over 6 percent of their market share.

3. "The Nursing Home Compare Report Card: perceptions of residents and caregivers regarding quality ratings and nursing home choice."

Schapira MM, Shea JA, Duey KA, Kleiman C, Werner RM.
Health Services Research 2016 Jun;51 Suppl 2:1212-28.
PUBMED link:

The researchers evaluated the perceived usefulness of publicly reported nursing home quality indicators. They found that star ratings, clinical quality measures, and benchmarking information were salient to decision making, with preferred formats varying across participants. Participants desired additional information on the source of quality data. Confusion was evident regarding the relationship between domain-specific and overall star quality ratings.

4. "Do consumers respond to publicly reported quality information? Evidence from nursing homes."

Werner RM, Norton EC, Konetzka RT, Polsky D.
Journal of Health Economics 2012 Jan;31(1):50-61.
PUBMED link:

The authors of this study examined the relationship between report card scores and patient choice of nursing home after the Centers for Medicare & Medicaid Services began publicly reporting nursing home quality information on post-acute care in 2002. They found that the relationship between reported quality and nursing home choice is positive and statistically significant. This suggests that patients were more likely to choose facilities with higher reported post-acute care quality after public reporting was initiated. Since the magnitude of the effect was small, the researchers concluded that there has been minimal consumer response to information in the post-acute care market.

5. "Nursing home 5-star rating system exacerbates disparities in quality, by payer source."

Konetzka RT, Grabowski DC, Perraillon MC, Werner RM.
Health Affairs 2015 May;34(5):819-27.
PUBMED link:

The researchers examined how the Centers for Medicare & Medicaid Services’ five-star rating system for nursing homes has affected residents who are dually enrolled in Medicare and Medicaid (“dual eligibles”). They found that by 2010 the increased likelihood of choosing the highest-rated homes was substantially smaller for dual eligibles than for non–dual eligibles.


Page last reviewed May 2018
Page originally created January 2016
Internet Citation: AHRQ Grant HS021861: Related Publication Summaries. Content last reviewed May 2018. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/sciencepubreport/hs021861.html