Abstract
Measurement of the quality of US health care increasingly emphasizes clinical outcomes over clinical processes. Nursing Home Compare Star Ratings are provided by Medicare to help select better nursing home care. The authors determined the rates and types of 2 important clinical outcomes–potentially preventable hospital admissions and potentially preventable emergency department (ED) visits–for a subset of 439,011 long-term nursing homes residents residing in 12,883 nursing homes throughout the United States over a 2-year period (2010–2011) and compared them with the Star Rating system. This study found that (1) the likelihood of potentially preventable events increases with increasing burden of chronic illness, (2) the principle reasons for hospital admissions and ED visits (eg, septicemia, pneumonia, confusion, gastroenteritis) are not part of existing nursing home quality measures, (3) the rate of potentially preventable admissions and ED visits for nursing homes residents varies greatly both across and within states, with 5 states having in excess of 20% more than the national average for both, and (4) the Nursing Home Compare Stars measure has limited correlation with rates of these potentially preventable events. Nursing Home Compare Star rankings could benefit by incorporating outcomes measures such as preventable hospitalizations and ED visits, and by comparing nursing home performance on results drawn from across states rather than within them. Such reform could better help users find nursing homes of higher quality and stimulate homes to improve quality in ways that benefit residents.
Highlights
There is considerable national interest in measuring the quality of health care outcomes
This study found that (1) the likelihood of potentially preventable events increases with increasing burden of chronic illness, (2) the principle reasons for hospital admissions and emergency department (ED) visits are not part of existing nursing home quality measures, (3) the rate of potentially preventable admissions and ED visits for nursing homes residents varies greatly both across and within states, with 5 states having in excess of 20% more than the national average for both, and (4) the Nursing Home Compare Stars measure has limited correlation with rates of these potentially preventable events
These rates are observed to increase with the complexity of the patient with the separation between the Aggregated Clinical Risk Groups (ACRGs) group rate and the overall average most pronounced for those enrollees with 3 or more chronic diseases or catastrophic conditions, such as individuals on total parenteral nutrition
Summary
There is considerable national interest in measuring the quality of health care outcomes This is of particular importance for long-term stay residents of nursing homes who are both vulnerable and dependent on the care provided by their residential facilities. Acute care events, such as hospitalizations and emergency department (ED) visits, paid via a separate payer source (Medicare) are monitored infrequently for nursing home quality because of the logistical challenges of matching claims data to residents. The study team identifies long-term nursing home residents from within a Medicare fee-for-service (FFS) claims database. The study team evaluates nursing home performance on PPAs and PPVs and their Star rankings assigned by the Centers for Medicare & Medicaid Services (CMS) to assess comparability. CMS created the 5-Star Rating System in 2008 as a guide to
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