Association Between 5-Star Nursing Home Report Card Ratings and Potentially Preventable Hospitalizations.
Association Between 5-Star Nursing Home Report Card Ratings and Potentially Preventable Hospitalizations.
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DOI：
10.1177/0046958018787323
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发表时间：
2018-01
期刊：
影响因子：
--
通讯作者：
Werner RM
中科院分区：
文献类型：
--
作者：
Ryskina KL;Konetzka RT;Werner RM
自从医疗保险和医疗补助服务中心的护理之家比较采用了5-星星评级系统以来，护理之家公开报道的星星评级大幅增加。我们的目标是测试疗养院5星星评级的提高是否与住院率的降低相关。我们假设，越来越多的关注5-星星星星评级激励养老院作出改变，提高他们的星星评级，但不影响他们的住院率，导致评级和住院之间的关联减弱。我们使用了2007-2010年医疗保险医院索赔和疗养院临床评估数据，比较了疗养院5-星星评级和住院率之间的相关性，之前和之后的5-星星评级公开发布。住院率和疗养院的5-星星评级之间的相关性在评级公开后略有减弱。这种相关性的下降集中在接受急性期后护理的患者中，他们在最佳护理之家经历了相对更多的住院治疗。在医疗保险的5-星星评级系统发布后，疗养院星星评级的改善并没有伴随着更广泛的急性护理后患者结局指标的改善。虽然这种分离可能是由于更好地匹配病情较重的患者，以更高质量的疗养院或表面的改善，疗养院，以增加他们的评级没有实质性的投资，在质量改进，5-星星评级，但成为不太有意义的指标，疗养院的质量为急性期后护理患者。
Nursing homes’ publicly reported star ratings increased substantially since Centers for Medicare & Medicaid Services’s Nursing Home Compare adopted a 5-star rating system. Our objective was to test whether the improvements in nursing home 5-star ratings were correlated with reductions in rates of hospitalization. We hypothesized that increased attention to 5-star star ratings motivated nursing homes to make changes that improved their star ratings but did not affect their hospitalization rate, resulting in a weakened association between ratings and hospitalizations. We used 2007-2010 Medicare hospital claims and nursing home clinical assessment data to compare the correlation between nursing home 5-star ratings and hospitalization rates before versus after 5-star ratings were publicly released. The correlation between the rate of hospitalization and a nursing home’s 5-star rating weakened slightly after the ratings became publicly available. This decrease in correlation was concentrated among patients receiving post-acute care, who experienced relatively more hospitalizations from best-rated nursing homes. The improvements in nursing home star ratings after the release of Medicare’s 5-star rating system were not accompanied by improvements in a broader measure of outcomes for post-acute care patients. Although this dissociation may be due to better matching of sicker patients to higher-quality nursing homes or superficial improvements by nursing homes to increase their ratings without substantial investments in quality improvement, the 5-star ratings nonetheless became less meaningful as an indicator of nursing home quality for post-acute care patients.
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