5. Public Reporting as a Quality Improvement Strategy

Table 6. Study findings: change in Nursing Home Compare quality measures
First Author, Year
(Quality Assessment)
Quality Measure
Long-Stay Residents
Increased help with
daily activities
Zinn,
2005 59
(Fair)
Mukamel,
2008 63
(Good)
Castle,
2008 60
(Fair)
106
Werner,
2009 13
shortstay
only
(Good)
Werner,
2010 58
shortstay
only
(Good)
Grabowski,
2011 61
(Good)
Gaudet,
2011 62
(Good)
↔ ↔ ↓ NR NR ↔ ↓
Pain ↑ NR ↑ NR NR NR ↑
Pressure sores a
↔ ↓ NR NR NR NR ↔
Pressure sores risk
adjusted a
High-risk with pressure
sores b
Low-risk with pressure
sores b
↔ NR NR NR NR NR NR
NR NR ↑ NR NR ↔ NR
NR NR ↑ NR NR ↔ NR
Physically restrained c ↑ ↑ ↑ NR NR ↔ ↑
More depressed b NR NR ↑ NR NR NR NR
Lose control of bowel
or bladder b
NR NR ↓ NR NR NR NR
Catheter b NR NR ↑ NR NR NR NR
Infection a ↔ ↔ NR NR NR NR NR
Most time in bed or
chair b
Worse ability to move
around b
NR NR ↔ NR NR NR NR
NR NR ↓ NR NR NR NR
Urinary tract infection c NR NR ↓ NR NR ↔ NR
Lose too much weight b NR NR ↓ NR NR NR NR
Short-Stay Residents
Delirium ↑ NR ↑ ↑ ↔ NR NR
Delirium risk adjusted a ↔ NR NR NR NR NR NR
Pain ↑ ↑ ↑ ↑ ↑ NR NR
Pressure sores b NR NR ↑ NR NR NR NR
Walking a ↔ NR NR ↑ ↔ NR NR
Note: ↑improvement; ↓worse; ↔ no change
a
Included only in 2002 and 2003.
b
Added in 2004.
c
Added in 2003.
NR = not reported
Key Question 2: Harms
Four studies examined different potential harms that could result from public reports about
LTC. Mukamel et al. (2009) 72 examined whether NHs changed their admission patterns and
admitted residents likely to improve the facility’s NH Compare scores; Werner et al. (2009b) 74
investigated whether NHs would focus on the publicly reported measures to the detriment of
other aspects of quality of care; Konetzka et al.(2012) 75 analyzed whether NHs were
rehospitalizing high risk postacute care patients before their first post admission assessment