5. Public Reporting as a Quality Improvement Strategy

Table 7. Summary of evidence: long-term care services (continued)
Author
Year
Public
Key
Results
(QA)
Report Study Overview
Question
↑ Improvement; ↓ Worse; ↔ No difference
Werner
2011 73
NH
Compared pilot and non pilot 2 Cream skimming
Compare States prior to and after NH
↔No evidence NHs admitted lower risk patients in order to improve NH Compare
(Good) for Post Compare to determine if
scores
Acute Care public reporting results in
Down coding
changes in the types of
↓Change in admission levels of pain (lower after public reporting) suggests facility
people choosing high and
may be down coding high risk patients
low quality providers (patient 4 Patient sorting; high risk patients admitted to higher quality NHs
sorting) occurred for
↑ 1 of 3 QMs.
postacute care.
Pain (correlation between higher risk on admission and high quality increased after
NH Compare.
N=8,139 NHs
10 point higher NH Compare score associated with 1% point increase in admission
pain level for following quarter
↔ 2 of 3 QMs Delirium and difficultly walking. No change
Werner
2012 107
NH
To determine if public
4 Selection of NHs (market share)
(Good)
Compare
for
reporting influences patients’
selection of NHs for
↑ 1 of 3 QMs; Pain
Change in a Pain score from 25
postacute
care
postacute care.
th to 74 th percentile (fewer patients with pain)
increases market share 1.3%
↔ 1 of 3 QMs; Delirium near zero
↓ 1 of 3 QMs; Walking
Counter intuitive result: improvement in score associated with decline in market share
6 Patient Education Level
↑ 3 of 3 QMs larger response to public reporting by patients with higher (High school
or more) education level
NH Occupancy/Capacity Constraints
↑ Greater impact on selection in markets with lower occupancy (lower capacity
constraints
Not reporting in NH Compare
↓ Smaller NHs not required to publicly report lose market share after public reporting,
suggesting patients interpret the lack of data as a sign of poor quality.
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