National Healthcare Quality and Disparities Report
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Topics
- Burnout (1)
- Disparities (1)
- Elderly (7)
- Health Information Technology (HIT) (1)
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- (-) Nursing Homes (21)
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- Pneumonia (1)
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- Provider: Nurse (1)
- (-) Provider Performance (21)
- Public Reporting (1)
- Quality Improvement (6)
- Quality Indicators (QIs) (5)
- Quality Measures (9)
- Quality of Care (18)
- Quality of Life (1)
- Shared Decision Making (2)
- Surveys on Patient Safety Culture (1)
- Urinary Tract Infection (UTI) (1)
- Vulnerable Populations (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 21 of 21 Research Studies DisplayedChen Z, Gleason LJ, Konetzka RT
Accuracy of infection reporting in US nursing home ratings.
The objective of this study was to assess the accuracy of publicly reported nursing home data on urinary tract infections (UTIs) and of pneumonia data, which are not publicly reported. Researchers developed a claims-based nursing home-level measure of hospitalized infections and estimated correlations between this and publicly reported ratings. Subjects were Medicare fee-for-service beneficiaries who were nursing home residents and hospitalized for UTI or pneumonia during the study period. Findings suggested that both UTI and pneumonia were substantially underreported in data used for national public reporting. The researchers concluded that alternative approaches were needed to improve surveillance of nursing home quality.
AHRQ-funded; HS026957.
Citation: Chen Z, Gleason LJ, Konetzka RT .
Accuracy of infection reporting in US nursing home ratings.
Health Serv Res 2023 Oct; 58(5):1109-18. doi: 10.1111/1475-6773.14195..
Keywords: Provider Performance, Nursing Homes, Long-Term Care, Pneumonia, Urinary Tract Infection (UTI), Elderly
Mao Y, Li Y, McGarry B
Are online reviews of assisted living communities associated with patient-centered outcomes?
The purpose of this study was to explore the relationship between assisted living (AL) online quality review ratings and AL residents' home time. The researchers identified Medicare beneficiaries who entered AL communities in 2018, with the main outcome of resident home time in the year after AL admission. Additional outcomes were the percentage of time spent in emergency room, inpatient hospital, nursing home, and inpatient hospice. The study sample included 59,831 residents in 12,143 ALs. AL online Google reviews for 2013-2017 were linked to 2018-2019 Medicare data. AL average rating score and rating status were generated using Google reviews. The study found that from 2013 to 2017, ALs received an average rating of 4.1 on Google, with a standard deviation of 1.1. Each one-unit increase in the AL's average online rating was associated with an increase in residents' risk-adjusted home time by 0.33 percentage points. Residents in high-rated ALs had a 0.64 pp increase in home time compared with residents in ALs without ratings. Thet study concluded that higher online rating scores were positively associated with residents' home time, and a lack of ratings was related with decreased home time.
AHRQ-funded; HS026893.
Citation: Mao Y, Li Y, McGarry B .
Are online reviews of assisted living communities associated with patient-centered outcomes?
J Am Geriatr Soc 2023 May; 71(5):1505-14. doi: 10.1111/jgs.18192..
Keywords: Elderly, Long-Term Care, Patient-Centered Healthcare, Nursing Homes, Provider Performance, Medicare, Medicaid
Konetzka 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
de Cordova PB, Johansen ML, Zha P
Does public reporting of staffing ratios and Nursing Home Compare ratings matter?
This study’s objective was to examine the association between publicly available staffing ratios and the Five-Star Quality Ratings from Nursing Home Compare over time. Findings showed that decreasing the number of residents assigned to a registered nurse in nursing homes resulted in an increase in staffing ratings. Mandatory public reporting held nursing homes accountable for quality outcomes but did not improve staffing ratios. Recommendations included continuing to focus on improving quality in nursing homes, which may improve staffing ratios across shifts.
AHRQ-funded; HS024339.
Citation: de Cordova PB, Johansen ML, Zha P .
Does public reporting of staffing ratios and Nursing Home Compare ratings matter?
J Am Med Dir Assoc 2021 Nov;22(11):2373-77. doi: 10.1016/j.jamda.2021.03.011..
Keywords: Nursing Homes, Quality of Care, Provider Performance
Ryskina KL, Andy AU, Manges KA
Association of online consumer reviews of skilled nursing facilities with patient rehospitalization rates.
The purpose of this study was to: 1.) assess the association between rehospitalization rates and online ratings of skilled nursing facility (SNFs); 2.) Compare the association of rehospitalization with ratings from a review website vs Medicare Nursing Home Compare (NHC) ratings; and 3.) Identify specific topics consistently reported in reviews of SNFs with the highest vs lowest rehospitalization rates using natural language processing.
AHRQ-funded; HS026116.
Citation: Ryskina KL, Andy AU, Manges KA .
Association of online consumer reviews of skilled nursing facilities with patient rehospitalization rates.
JAMA Netw Open 2020 May;3(5):e204682. doi: 10.1001/jamanetworkopen.2020.4682..
Keywords: Nursing Homes, Hospital Readmissions, Provider Performance, Quality of Care, Medicare, Elderly
White EM, Aiken LH, Sloane DM
Nursing home work environment, care quality, registered nurse burnout and job dissatisfaction.
The objective of this cross-sectional study was to examine the relationships between work environment, care quality, registered nurse (RN) burnout, and job dissatisfaction in nursing homes. In this study, the investigators linked 2015 RN4CAST-US nurse survey data with LTCfocus and Nursing Home Compare. They indicate that their results suggest that the work environment is an important area to target for interventions to improve care quality and nurse retention in nursing homes.
AHRQ-funded; HS000011.
Citation: White EM, Aiken LH, Sloane DM .
Nursing home work environment, care quality, registered nurse burnout and job dissatisfaction.
Geriatr Nurs 2020 Mar-Apr;41(2):158-64. doi: 10.1016/j.gerinurse.2019.08.007..
Keywords: Elderly, Nursing Homes, Burnout, Provider: Nurse, Provider, Quality of Care, Provider Performance
Sharma H, Konetzka RT, Smieliauskas F
The relationship between reported staffing and expenditures in nursing homes.
AHRQ-funded; HS024967.
Citation: Sharma H, Konetzka RT, Smieliauskas F .
The relationship between reported staffing and expenditures in nursing homes.
Med Care Res Rev 2019 Dec 1;76(6):758-83. doi: 10.1177/1077558717739214..
Keywords: Nursing Homes, Long-Term Care, Quality Improvement, Quality of Care, Provider Performance, Medicare
Kim KL, LI L, Kuang M
Changes in hospital referral patterns to skilled nursing facilities under the Hospital Readmissions Reduction Program.
The objective of this study was to investigate the association between changes in hospital referral patterns to skilled nursing facilities (SNFs) and Hospital Readmissions Reduction Program (HRRP) penalty pressure. Results showed that HRRP did not prompt substantial changes in hospital referral patterns to SNFs, although readmissions for patients referred to SNFs differentially decreased more than for other patients, warranting investigation of other mechanisms underlying readmissions reduction.
AHRQ-funded; HS022882.
Citation: Kim KL, LI L, Kuang M .
Changes in hospital referral patterns to skilled nursing facilities under the Hospital Readmissions Reduction Program.
Med Care 2019 Sep;57(9):695-701. doi: 10.1097/mlr.0000000000001169..
Keywords: Hospitals, Nursing Homes, Hospital Readmissions, Payment, Provider Performance
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
Perraillon MC, Brauner DJ, Konetzka RT
Nursing home response to Nursing Home Compare: the provider perspective.
This paper examined the validity of quality ratings of nursing homes with Nursing Home Compare (NHC) and assessed the views of nursing home administrators and staff. There was a conflict found between improving ratings and competing goals of maximizing profits and avoidance of litigation. Since the NHC is self-reported there is controversy on its validity due to self-reporting bias.
AHRQ-funded; HS018718.
Citation: Perraillon MC, Brauner DJ, Konetzka RT .
Nursing home response to Nursing Home Compare: the provider perspective.
Med Care Res Rev 2019 Aug;76(4):425-43. doi: 10.1177/1077558717725165..
Keywords: Long-Term Care, Nursing Homes, Provider Performance, Quality of Care, Quality Improvement
Perraillon MC, Konetzka RT, He D
Consumer response to composite ratings of nursing home quality.
Health care report cards are intended to address information asymmetries and enable consumers to choose providers of better quality. This study examined whether the form of the information mattered to consumers. The investigators concluded that the form of quality reporting mattered to consumers, and that the increased use of composite ratings was likely to increase consumer response.
AHRQ-funded; HS021877; HS021861; HS000084.
Citation: Perraillon MC, Konetzka RT, He D .
Consumer response to composite ratings of nursing home quality.
Am J Health Econ 2019 Spring;5(2):165-90. doi: 10.1162/ajhe_a_00115..
Keywords: Nursing Homes, Long-Term Care, Quality of Care, Provider Performance, Quality Measures
Zuckerman RB, Wu S, Chen LM
The five-star skilled nursing facility rating system and care of disadvantaged populations.
AHRQ-funded; HS000029.
Citation: Zuckerman RB, Wu S, Chen LM .
The five-star skilled nursing facility rating system and care of disadvantaged populations.
J Am Geriatr Soc 2019 Jan;67(1):108-14. doi: 10.1111/jgs.15629..
Keywords: Nursing Homes, Vulnerable Populations, Medicare, Elderly, Provider Performance, Quality of Care, Hospital Discharge, Disparities
Brauner D, Werner RM, Shippee TP
Does Nursing Home Compare reflect patient safety in nursing homes?
In this study the investigators compared nursing homes' performance on several composite quality measures from Nursing Home Compare, the most prominent recent example of a national policy aimed at improving the quality of nursing home care, to their performance on measures of patient safety in nursing homes such as pressure sores, infections, falls, and medication errors.
AHRQ-funded; HS024967.
Citation: Brauner D, Werner RM, Shippee TP .
Does Nursing Home Compare reflect patient safety in nursing homes?
Health Aff 2018 Nov;37(11):1770-78. doi: 10.1377/hlthaff.2018.0721.
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Keywords: Quality of Care, Nursing Homes, Patient Safety, Provider Performance, Quality Measures
Alexander GL, Madsen R
A national report of nursing home quality and information technology: two-year trends.
The authors sought to answer these two research questions: What are the trends in information technology (IT) adoption in US nursing home facilities over 2 years? How are 2-year trends in IT adoption in US nursing homes related to nationally reported quality measures (QMs)? Using surveys of nursing home administrators and data from Nursing Home Compare, they concluded that multiple dimensions of IT sophistication influence QMs in every health care domain, providing an opportunity to design a reporting system that joins these important variables to be assessed on a national scale.
AHRQ-funded; HS022497.
Citation: Alexander GL, Madsen R .
A national report of nursing home quality and information technology: two-year trends.
J Nurs Care Qual 2018 Jul/Sep;33(3):200-07. doi: 10.1097/ncq.0000000000000328.
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Keywords: Health Information Technology (HIT), Nursing Homes, Long-Term Care, Quality of Care, Quality Measures, 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
Wang Y, Pandolfi MM, Fine J
Community level association between home health and nursing home performance on quality and hospital 30-day readmissions for Medicare patients.
Using CMS data from 2010 to 2012, the researchers evaluated whether community-level home health agencies and nursing home performance is associated with community-level hospital 30-day all-cause risk-standardized readmission rates for Medicare patients. They found that increasing nursing home performance by one star for all of its 4 measures and home health performance by 10 points for all of its 6 measures is associated with decreases in community-level risk-standardized readmission rates.
AHRQ-funded; HS023000.
Citation: Wang Y, Pandolfi MM, Fine J .
Community level association between home health and nursing home performance on quality and hospital 30-day readmissions for Medicare patients.
Home Health Care Manag Pract 2016 Nov;28(4):201-08. doi: 10.1177/1084822316639032.
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Keywords: Quality of Care, Hospital Readmissions, Home Healthcare, Nursing Homes, Provider Performance
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
Abrahamson K, Miech E, Davila HW
Pay-for-performance policy and data-driven decision making within nursing homes: a qualitative study.
The researchers explored ways in which data were collected, thought about and used by nursing home employees as a result of participation in a pay-for-performance (P4P) program. Their findings indicated that participants in the Minnesota Performance-based Incentive Payment Program’s quality improvement (QI) projects perceived a change in the rate and manner in which they gathered, used, and considered data in their QI decisions.
AHRQ-funded; HS018464
Citation: Abrahamson K, Miech E, Davila HW .
Pay-for-performance policy and data-driven decision making within nursing homes: a qualitative study.
BMJ Qual Saf. 2015 May;24(5):311-7. doi: 10.1136/bmjqs-2014-003362..
Keywords: Nursing Homes, Long-Term Care, Payment, Provider Performance, Shared Decision Making, Policy, Quality Improvement, Quality of Care
Werner RM, Konetzka RT, Kim MM
Quality improvement under nursing home compare: the association between changes in process and outcome measures.
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 key to successfully achieving broad quality improvements across nursing homes.
AHRQ-funded; HS021861.
Citation: Werner RM, Konetzka RT, Kim MM .
Quality improvement under nursing home compare: the association between changes in process and outcome measures.
Med Care 2013 Jul;51(7):582-8. doi: 10.1097/MLR.0b013e31828dbae4.
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Keywords: Nursing Homes, Long-Term Care, Quality Improvement, Quality Measures, Quality of Care, Provider Performance, Outcomes
Pesis-Katz I, Phelps CE, Temkin-Greener H
AHRQ Author: Spector WD
Making difficult decisions: the role of quality of care in choosing a nursing home.
The authors investigated how quality of care affects nursing home choice. They examined choices in California, Ohio, New York, and Texas, in 2001. They found that, in all states, consumers were more likely to choose nursing homes of high hotel services quality but not clinical care quality; choice was also significantly associated with shorter distance from prior residence, not-for-profit status, and larger facility size.
AHRQ-authored.
Citation: Pesis-Katz I, Phelps CE, Temkin-Greener H .
Making difficult decisions: the role of quality of care in choosing a nursing home.
Am J Public Health 2013 May;103(5):e31-7. doi: 10.2105/ajph.2013.301243.
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Keywords: Shared Decision Making, Quality of Care, Nursing Homes, Provider Performance, Quality of Life