Quality report cards have become an important component of the American health care system in recent decades. The Centers for Medicare and Medicaid Services (CMS) publishes several web based report cards, including the Nursing Home Compare (NHC). It offers patients and their families'information about staffing, deficiencies, and 19 clinical quality measures (QMs). The objectives of these reports are to inform consumers'choice and improve quality of care. The evidence about their success in achieving these goals is mixed. Studies to-date suggests that many report cards are not widely used or not used at all. This is not surprising given both the complexity of the information and the fact that nursing home choices are typically made under both time constraints and in emotionally stressful situations, typically when the elder has to be discharged from the hospital. The objective of the proposed project is to develop and test a new e-coaching approach designed to take advantage of web technology and decision support software in order to facilitate and enhance access to and use of NHC.
The Specific Aims of the project are: 1) To develop a consumer friendly web-based interface between NHC and an e-coaching/decision-aid tool. 2) To test its effectiveness through a randomized control trial. The project will be conducted at the University of California, Irvine Medical Center and will include medical and surgical patients identified by the attending as likely to be discharged to a nursing home. In year 1 we will develop a decision-aid tool, pilot test it with patients and families and build a web application that will integrate and interact with the NHC data guided by users'response to queries. In year 2 we will test the application we developed in the treatment group. The control group will continue with the usual discharge practice. Both groups will be surveyed. In year 3 survey data, data about the use patterns of the application, and data about the quality of nursing home destination facilities will be analyzed to test the study hypotheses. The lessons learned from this study will have direct application to improving the use of NHC by consumers. They may also be relevant to other report cards in the "Compare" series, Home Care Compare in particular.
Quality report cards are published by governments and private organizations with the expectation that they will inform consumers'choice of providers and increase the incentives for providers to improve quality. This study will enhance the ability of consumers to access the information in report cards and incorporate it into their decision making process. This in turn will increase the effectiveness of report cards.
|Mukamel, Dana B; Haeder, Simon F; Weimer, David L (2014) Top-down and bottom-up approaches to health care quality: the impacts of regulation and report cards. Annu Rev Public Health 35:477-97|