How good is Nursing Home Compare?

In the past few weeks, I discussed how well Hospital Compare does on measuring the quality of hospital care (see here and here).  Now, I turn to how well Nursing Home Compare does on truly measuring quality of care.  A study by Brauner et al. (2018) attempts to answer this question.  They compare the quality results from Hospital Compare with results from the Certification and Survey Provider Enhanced Reporting (CASPER) system.  Specifically, the authors look at six quality metrics: injurious falls, urinary tract infections, and pressure sores among long-stay residents; pressure sores among short-stay residents; and two measures of medication errors.  The first four of these measurements come from the Minimum Data Set (MDS) assessment file; the other two measures come from deficiency citations from health inspections.

The authors look at the correlation between measures and also perform the following analysis:

We used analysis-of-variance tests to test for groupwise differences. If NHC serves as a good marker for patient safety, the means should be highest for one-star homes and lowest for five-star homes, with a monotonic trend in between.

Based on this approach, they found that the quality was most correlated for pressure sore metrics among long-stay residents but very weakly correlated for the urinary tract infection metric for these patients.  In general:

Nursing Home Compare…does not provide them with much information on which to judge patient safety in nursing homes….we found that although there was some correlation between NHC star ratings and patient safety measures, these tended to be weak—and for many safety measures, nonexistent. A rating of one star or five stars seemed to give the most information about patient safety, with one-star nursing homes having higher rates of adverse safety events and five-star nursing homes having the lowest rates. However, for nursing homes in the middle—those with two, three, or four stars— there was no meaningful difference in adverse safety events between nursing homes with different star ratings.

In short, Nursing Home Compare, provides some, but limited quality information for those using it as a guide to choose a nursing home.

Source:

• Daniel Brauner, Rachel M. Werner, Tetyana P. Shippee, John Cursio, Hari Sharma, and R. Tamara Konetzka. Does Nursing Home Compare Reflect Patient Safety In Nursing Homes? Health Affairs. 37, NO. 11 (2018): 1770–1778. DOI: 10.1377/hlthaff.2018.0721

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