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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 5 of 5 Research Studies DisplayedKonetzka RT, Davila H, Brauner DJ
The quality measures domain in Nursing Home Compare: is high performance meaningful or misleading?
The Federal Centers for Medicare and Medicaid Services publishes a Nursing Home Compare (NHC) web site that provides information to compare nursing homes across the nation. Since NHC began reporting the percent of nursing home residents suffering adverse outcomes, the negative outcomes decreased dramatically. However, the validity of scores has been questioned for nursing homes that score well on facility-reported measures but scored poorly on inspections. The study purpose was to determine whether nursing homes with these “discordant” scores are better than nursing homes that score poorly across all domains. The researchers analyzed national data from 2012- 2016, conducted in-depth interviews and observations of 12 nursing homes in 2017 to 2018, and studied nursing home performance trajectories over time. Both qualitative and quantitative methods were utilized and interpreted together. The study found that facilities identified as discordant took part in more quality improvement (QI) activities than those identified as poor performers, but those QI activities were lower-resource improvements and not of the type and scope that would impact improvements across other quality domains. It was determined that the poor-performing facilities appeared to lack the leadership and staff continuity required for even low-resource improvements. The study concluded that while high performance on quality measures using facility-reported data is mostly meaningful, and the quality measures domain should continue to be utilized in Nursing Home Compare, facilities identified as discordant still have quality defects.
AHRQ-funded; HS024967.
Citation: Konetzka RT, Davila H, Brauner DJ .
The quality measures domain in Nursing Home Compare: is high performance meaningful or misleading?
Gerontologist 2022 Feb 9;62(2):293-303. doi: 10.1093/geront/gnab054..
Keywords: Nursing Homes, Long-Term Care, Provider Performance, Quality Indicators (QIs), Quality Measures, Quality of Care
Davila H, Shippee TP, Park YS
Inside the black box of improving on nursing home quality measures.
This qualitative study investigated how nursing homes (NHs) interact with quality measures (QMs) used by Nursing Home Compare (NHC) as part of its 5-star rating system. Semistructured interviews were conducted with 110 NH personnel and 23 NH provider association representatives. Observations of organizational processes in 12 NHs in three states were also done. The authors found that most NHs are working to improve the quality of care they provide, not merely to improve their QM scores. They also found limitations with the QMs, suggesting that the QMs on their own may not accurately reflect the quality of care that NHs provide. The findings suggest several changes to improve NHC.
AHRQ-funded; HS024967.
Citation: Davila H, Shippee TP, Park YS .
Inside the black box of improving on nursing home quality measures.
Med Care Res Rev 2021 Dec;78(6):758-70. doi: 10.1177/1077558720960326..
Keywords: Nursing Homes, Quality Indicators (QIs), Quality Measures, Quality Improvement, Quality of Care, Provider Performance, Long-Term Care
Li Y, Cen X, Cai X
Perceived patient safety culture in nursing homes associated with "Nursing Home Compare" performance indicators.
This study examined the association between the use of “Nursing Home Compare” performance indicators and improved patient safety culture in nursing homes. A survey was conducted in 2017 using AHRQ’s Survey on Patient Safety Culture for Nursing Homes which collects data on 12 core domains of safety culture scores. Out of 2254 nursing homes sampled, there was a response rate of 36%. It was found that for every 10 percentage points increase in overall positive response rate for safety culture, there was an association with 0.56 fewer health care deficiencies, 0.74 fewer substantiated complaints, reduced fines by $2285.20, and 20% increased odds of being designed as 4-star or 5-star.
AHRQ-funded; HS024923.
Citation: Li Y, Cen X, Cai X .
Perceived patient safety culture in nursing homes associated with "Nursing Home Compare" performance indicators.
Med Care 2019 Aug;57(8):641-47. doi: 10.1097/mlr.0000000000001142..
Keywords: Surveys on Patient Safety Culture, Patient Safety, Nursing Homes, Quality Indicators (QIs), Quality Measures, Quality of Care, Provider Performance
Ryskina KL, Konetzka RT, Werner RM
Association between 5-Star nursing home report card ratings and potentially preventable hospitalizations.
The goal of this study was to test whether the improvements in nursing homes’ 5-star ratings were correlated with reductions in rates of hospitalization; the researchers’ hypothesis was that increased attention to ratings motivated nursing homes to make changes to improve ratings but did not affect hospitalization rate, resulting in a weakened association between ratings and hospitalizations. 2007-2010 Medicare hospital claims and nursing home clinical assessment data were used to compare the correlation between nursing homes’ ratings and hospitalization rates. Correlation weakened slightly after the ratings became publicly available. The researchers conclude that improvements in nursing home ratings after the release of Medicare's 5-star rating system were not accompanied by improvements in a broader measure of outcomes for post-acute care patients and, although this dissociation may be due to additional factors, the 5-star ratings became less meaningful as an indicator of nursing home quality for these patients.
AHRQ-funded; HS021861.
Citation: Ryskina KL, Konetzka RT, Werner RM .
Association between 5-Star nursing home report card ratings and potentially preventable hospitalizations.
Inquiry 2018 Jan-Dec;55:46958018787323. doi: 10.1177/0046958018787323..
Keywords: Elderly, Nursing Homes, Medicare, Quality Indicators (QIs), Provider Performance, Quality Measures, Hospitalization, Quality of Care
Mukamel DB, Ye Z, Glance LG
Does mandating nursing home participation in quality reporting make a difference? Evidence from Massachusetts.
This study investigated one of the mechanisms that may detract from the effectiveness of quality report cards: voluntary versus mandatory participation of nursing homes in public quality reporting. It found that once reporting became mandatory, nonvolunteers improved more than volunteers in all but 2 staffing measures.
AHRQ-funded; HS021844.
Citation: Mukamel DB, Ye Z, Glance LG .
Does mandating nursing home participation in quality reporting make a difference? Evidence from Massachusetts.
Med Care 2015 Aug;53(8):713-9. doi: 10.1097/mlr.0000000000000390..
Keywords: Nursing Homes, Long-Term Care, Public Reporting, Provider Performance, Quality Improvement, Quality of Care, Quality Indicators (QIs), Quality Measures, Elderly