5. Public Reporting as a Quality Improvement Strategy
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5. Public Reporting as a Quality Improvement Strategy

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Table 7. Summary of evidence: long-term care services (continued)<br />

Author<br />

Year<br />

<strong>Public</strong><br />

Key<br />

Results<br />

(QA)<br />

Report Study Overview<br />

Question<br />

↑ <strong>Improvement</strong>; ↓ Worse; ↔ No difference<br />

Zinn<br />

2005 59<br />

NH<br />

Assessed quality<br />

1 Post NH Compare:<br />

Compare improvement using NH<br />

↑Long stay: pain, physical restraints<br />

(Fair)<br />

Compare quarterly reports<br />

Short stay: delirium, pain<br />

from November 2002 (first<br />

↔Long stay: daily t<strong>as</strong>ks, PU, PU risk adjusted, infection<br />

publication) through January<br />

Short stay: delirium risk adjusted, walking<br />

2004 for all NHs reporting. 6 Characteristics compared on rate of improvement. End level w<strong>as</strong> still higher even<br />

though improvement is f<strong>as</strong>ter for NH with characteristics (the trend lines do not cross)<br />

(N=over 13,00 for long-stay<br />

Long Stay Residents<br />

resident me<strong>as</strong>ures, over<br />

↑ Pain higher rate of improvement in hospital-b<strong>as</strong>ed vs. not hospital-b<strong>as</strong>ed<br />

9,000 for short-stay resident<br />

Short Stay Residents<br />

me<strong>as</strong>ures)<br />

↑ Delirium higher rate of improvement with low occupancy rate vs. high<br />

↑ Pain higher rate of improvement in non chain vs. chain NH<br />

Zinn<br />

2008 79<br />

NH<br />

Cross-sectional comparison 3 37% took immediate action due to NH Compare; 30% took no action<br />

Compare of response to NH Compare<br />

(Good)<br />

by different types of strategic<br />

Found differences in responses by strategic type of administrator<br />

orientation:<br />

• Respond immediately: Prospectors<br />

Prospectors changed<br />

• Take no action: Defenders<br />

frequently and valued<br />

innovation and flexibility.<br />

Defenders focused on core<br />

services and emph<strong>as</strong>ize<br />

operating efficiencies.<br />

Analyzers blended<br />

characteristics of the first<br />

two.<br />

Reactors lacked a strategy.<br />

6<br />

• Communicate with families about public report: No strategic type<br />

• Investigate re<strong>as</strong>ons for scores: Prospectors and analyzers<br />

• Revise job descriptions: Prospectors<br />

• Invest in equipment of technology: No strategic type<br />

37% took immediate action due to NH Compare; 30% took no action<br />

Characteristics of NH more like to take these actions:<br />

• Respond immediately: Nonprofits, high competition<br />

• Take no action: Poor initial quality, low competition<br />

• Communicate with families about public report: High competition, chain<br />

Survey responds for 10%<br />

sample of administrators.<br />

724 completed survey<br />

(48.2%)<br />

• Investigate re<strong>as</strong>ons for scores: Poor initial scores<br />

• Revise job descriptions: Poor initial scores<br />

• Invest in equipment of technology: different by no NH characteristics<br />

121

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