AHRQ Grant HS021877: Related Publication Summaries

Improving Nursing Home Compare for Dually Eligible Consumers

1. "Shipping out instead of shaping up: Rehospitalization from nursing homes as an unintended effect of public reporting."

Konetzka RT, Polsky D, Werner RM.
Journal of Health Economics 2013 Mar; 32(2):341-52.
PUBMED link:

To assess whether selective rehospitalization of nursing home residents occurred when public reports were instituted in 2002, the researchers examined data on post-acute patients of skilled nursing facilities nationwide during 1999-2005. They concluded that nursing homes rehospitalize higher-risk, post-acute patients to improve scores, providing evidence for selection behavior on the part of nursing home providers in the presence of public reporting.

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

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

The authors assessed the extent to which dual eligible (those enrolled in both Medicare and Medicaid) and non-dual eligibles avoided the lowest-rated nursing homes and chose the highest-rated homes once the five-star rating system began, in late 2008. They found that both populations resided in better quality homes over time, but that by 2010 the increased likelihood of choosing the highest-rated homes was substantially smaller for dual eligibles than for non-dual eligibles. This is likely due in part to higher-rated homes being located in more affluent areas. They suggest that increases in Medicaid payment rates for nursing home services may be the only long-term solution.

3. "Understanding why patients with COPD get readmitted: A large national study to delineate the Medicare population for the readmissions penalty expansion."

Shah T, Churpek MM, Coca Perraillon M, Konetzka RT.
Chest 2015 May;147(5):1219-26.
PUBMED link:

This study examined Medicare claims data from 2006 to 2010 in seven States with an index admission for chronic obstructive pulmonary disease (COPD). Over the study period, there were 26,798,404 inpatient admissions, of which 3.5% were index COPD admissions. At 30 days, 20.2% were readmitted to the hospital. Patients discharged home without home care were more likely to be readmitted for COPD than patients discharged to post-acute care, and were more likely to be dually enrolled in Medicare and Medicaid. This suggests that hospitals may be penalized under CMS’ Hospital Readmissions Reduction Program as a result of treating a poorer, sicker mix of patients.

4. "The effects of public reporting on physical restraints and antipsychotic use in nursing home residents with severe cognitive impairment."

Konetzka RT, Brauner DJ, Shega J, Werner RM.
Journal of the American Geriatric Society 2014 Mar;62(3):454-61.
PUBMED link:

This study compared use of physical restraints for nursing home (NH) residents with severe cognitive impairment in 4,258 nursing homes in six States from 1999 to 2008 among NHs subject to public reporting of physical restraints and those without reporting requirements. Physical restraint use declined significantly during the study period, but was larger in NHs that were subject to reporting of restraints. Correspondingly, antipsychotic use in the same residents increased more in NHs subject to public reporting, which may have been an unintended consequence of public reporting of physical restraint use.

5. "Use of Nursing Home Compare website appears limited by lack of awareness and initial mistrust of the data."

Konetzka RT, Perraillon MC.
Health Affairs 2016 Apr;35(4):706-13.
PUBMED link:

The researchers used a qualitative assessment of how consumers select nursing homes and the role of information about quality, using semi-structured interviews of people who recently placed a family member or friend in a nursing home. They found that consumers had a positive reaction when shown Nursing Home Compare; however, its use appeared to be limited by lack of awareness and, to some extent, initial lack of trust of the data.

6. "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.   

7. "The role of severe dementia in nursing home report cards."

Konetzka RT, Brauner DJ, Coca Perraillon M, Werner RM.
Medical Care Research Review 2015 Oct;72(5):562-79.
Pubmed LINK:

This article examined the intended and unintended effects of quality reporting for nursing home residents with severe dementia relative to other residents, using a difference-in-differences design to examine selected reported and unreported quality measures. The results indicate that prior to public reporting, nursing home residents with severe dementia were at significantly higher risk of poor outcomes on most reported quality measures.

8. "Public reporting and demand rationing: evidence from the nursing home industry"

He D, Konetzka RT.
Health Economics 2015 Nov;24(11):1437-51.
PUBMED link:

The authors examined a consequence of public reporting: the potential for demand rationing. They found that high-quality nursing homes facing capacity constraints reduced admissions of less profitable Medicaid residents while increasing the more profitable Medicare and private-pay admissions, relative to low-quality nursing homes facing no capacity constraints.

9. "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):582-8.
PUBMED link:

The researchers tested the extent to which improvements in outcomes of care are explained by changes in nursing home processes. Of the 5 outcome measures examined, they found that only improvements in the percentage of nursing home residents in moderate or severe pain were associated with changes in nursing home processes of care. They concluded that understanding the mechanism behind improvements in nursing home outcomes may be the key to successfully achieving broad quality improvements across nursing homes.


Page last reviewed May 2018
Page originally created January 2016
Internet Citation: AHRQ Grant HS021877: 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/hs021877.html