Nursing home adoption of the National Healthcare Safety Network Long-term Care Facility Component

Abstract

Health care-associated infections pose a significant problem in nursing homes (NHs). The Long-term Care Facility Component of the National Healthcare Safety Network (NHSN) was launched in 2012, and since then, enrollment of NHs into NHSN has been deemed a national priority. Our goal was to understand the characteristics of NHs reporting to the NHSN compared to other NHs across the country. To meet this goal, we quantified the characteristics of NHs by NHSN enrollment status and reporting consistency using the Certification and Survey Provider Enhanced Reporting (CASPER) data linked to NHSN enrollment and reporting data. Of the 16,081 NHs in our sample, 262 (or 1.6% of NHs) had enrolled in NHSN by the end of 2015; these early adopting facilities were more likely to be for-profit and had a higher percentage of Medicare residents. By the end of 2016, enrollment expanded by more than 5-fold to 1,956 facilities (or 12.2% of NHs). In our analysis, the characteristics of those later adopting NHs were more similar to NHs nationally than the early adopters. Specifically, bed size and hospital-based facilities were related to both early and late adoption of NHSN. The types of NHs that have enrolled in NHSN have changed substantially since the program began. The increased enrollment was likely due to the Centers for Medicare & Medicaid (CMS)-funded "C. difficile Infection (CDI) Reporting and Reduction Project" that incentivized Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) to support NH enrollment and participation in NHSN. Further understanding of a facility's ability to enroll in and maintain reporting to NHSN, and how this relates to infection prevention staffing and infrastructure in NHs and infection rates among NH residents, is needed.