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Posted: February 05, 2008

Nursing Homes Improve Care When Spotlighted in Online Report Card

Some aspects of care in the nation’s nursing homes are improving as a result of a consumer-oriented online report card administered by the federal government’s Medicare watchdog agency, according to a new study.
 
The Centers for Medicare & Medicaid Services began publishing the “Nursing Home Compare” report card on the Web in 2002. The site is open to the public and gives detailed information about the past performance of every Medicare- and Medicaid-certified nursing home in the United States.
 
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According to lead investigator Dana Mukamel, Ph.D., the study is the first “to investigate the impact of a report card on quality of nursing home care.” Previous such studies have focused on health plans, hospitals or physicians. This study will appear online and in the upcoming issue of the journal Health Services Research.
 
Mukamel, a researcher at the Center for Health Policy Research and the Department of Medicine at the University of California at Irvine, said that the online report cards can have a policy-level impact: “If patients, physicians, social workers and state regulators use these report cards, nursing homes will see strong economic incentives to invest in quality care.”
 
Mukamel and colleagues surveyed a random sampling of Medicare- and Medicaid-certified nursing homes that had had at least one quality measure published on the first “Nursing Home Compare” report in 2002. About 700 facilities responded to the survey.
 
The researchers then looked at changes in five of the most important quality measures of nursing home care.
 
For long-term nursing home residents, quality measures included the percentages of residents with a worsening ability to perform daily living skills, who developed new infections or pressure ulcers, and who were physically restrained. For short-term residents, Mukamel’s study focused on the percentage of residents with moderate daily pain or any episodes of excruciating pain.
 
Researchers found that the quality measures of physical restraint and short-term pain improved after publication of the report card. Each category showed an improvement of about 10 percent from the study’s starting point.
 
However, the other measures did not show improvement. “This may reflect the longer lead time required before improvement can be observed in these other areas of care,” Mukamel said
 
Marilyn Rantz, Ph.D., R.N., a researcher in nursing home quality at the University of Missouri, agreed: “The lack of improvement in infections, pressure ulcers and the ability to perform living skills doesn’t mean the report cards aren’t useful. These quality measures are more clinically complex and require greater intervention for improvement.”
 
“Report cards are not perfect, but we’ve got to have some sort of measurement not only for the nursing home industry to use, but for consumers to compare nursing homes,” said Rantz, who was not associated with the study. “This study provides evidence that quality report cards are useful tools.”
 
According to Mukamel, the report cards provide patients and families with information that was unavailable just four or five years ago. “When they are at the point where they need to choose a nursing home they can go to on the Web and compare nursing homes available in their neighborhoods. They can see which ones have better outcomes.”
 
The Nursing Home Compare service is available by clicking here.

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