Quality of care in many of the nation's nursing homes has been long recognized as inadequate despite efforts to reform and strengthen regulations. A more recent CMS policy initiative designed to improve quality relies on publication of nursing home quality report cards, which allow patients to easily compare relative quality ranking of competing nursing homes. Publication of such report cards is expected to provide nursing facilities with positive incentives to improve the quality of care they offer. Report cards may, however, also lead nursing homes to adopt """"""""dysfunctional"""""""" strategies, such as """"""""cream skimming"""""""" or """"""""teaching to the test"""""""". Such strategies may adversely affect quality and access to nursing home care. The empirical evidence about the response of health care organizations in general, and nursing homes in particular, to such report cards is scant and inconclusive. In the proposed study we will examine the response of nursing homes to the publication of the CMS quality report cards and will answer two questions: 1) What factors determine which strategies nursing homes adopt in response to quality reports? And 2) what is the impact of such strategies on quality? The proposed study will compare data from the period prior to publication of the report to data from a period following publication to examine changes in behavior of nursing homes. We will create a comprehensive data set with information about: 1) the strategies that nursing homes adopted following publication and their views of the quality report cards (based on a national survey of nursing homes), 2) quality before and after publication of the reports measured along different dimensions, including those published in the reports, others that are not published, and hotel quality (based on MDS data merged with Medicare enrollment data and data on resource use obtained from nursing home cost reports) and 3) information about changes in admission profiles (MDS data). Statistical regression techniques will be used to analyze the data and test specific hypotheses.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG023177-03
Application #
7060422
Study Section
Social Sciences, Nursing, Epidemiology and Methods 4 (SNEM)
Program Officer
Stahl, Sidney M
Project Start
2004-05-01
Project End
2009-04-30
Budget Start
2006-06-01
Budget End
2007-04-30
Support Year
3
Fiscal Year
2006
Total Cost
$264,654
Indirect Cost
Name
University of California Irvine
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
046705849
City
Irvine
State
CA
Country
United States
Zip Code
92697
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
Mukamel, Dana B; Spector, William D; Zinn, Jacqueline et al. (2010) Changes in clinical and hotel expenditures following publication of the nursing home compare report card. Med Care 48:869-74
Zinn, Jacqueline S; Weimer, David L; Spector, William et al. (2010) Factors influencing nursing home response to quality measure publication: A resource dependence perspective. Health Care Manage Rev 35:256-65
Mukamel, Dana B; Ladd, Heather; Weimer, David L et al. (2009) Is there evidence of cream skimming among nursing homes following the publication of the Nursing Home Compare report card? Gerontologist 49:793-802
Zinn, Jacqueline S; Spector, William D; Weimer, David L et al. (2008) Strategic orientation and nursing home response to public reporting of quality measures: an application of the miles and snow typology. Health Serv Res 43:598-615
Mukamel, Dana B; Glance, Laurent G; Li, Yue et al. (2008) Does risk adjustment of the CMS quality measures for nursing homes matter? Med Care 46:532-41
Mukamel, Dana B; Weimer, David L; Spector, William D et al. (2008) Publication of quality report cards and trends in reported quality measures in nursing homes. Health Serv Res 43:1244-62
Mukamel, Dana B; Weimer, David L; Mushlin, Alvin I (2007) Interpreting market share changes as evidence for effectiveness of quality report cards. Med Care 45:1227-32
Mukamel, Dana B; Spector, William D; Zinn, Jacqueline S et al. (2007) Nursing homes'response to the nursing home compare report card. J Gerontol B Psychol Sci Soc Sci 62:S218-25