Underreporting of Quality Measures and Associated Facility Characteristics and Racial Disparities in US Nursing Home Ratings.
Underreporting of Quality Measures and Associated Facility Characteristics and Racial Disparities in US Nursing Home Ratings.
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DOI：
10.1001/jamanetworkopen.2023.14822
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发表时间：
2023-05-01
影响因子：
13.8
通讯作者：
Chen, Zihan
中科院分区：
文献类型：
--
作者：
Sanghavi, Prachi;Chen, Zihan
这项质量改进研究评估了美国各地疗养院的严重伤害福尔斯和压疮的设施报告率，并调查了疗养院的特点是否与这些措施的漏报有关。在护理之家护理比较（NHCC）网站上，护理之家的特征与重大损伤福尔斯和压疮的报告率相关程度如何？在这项涉及13179家疗养院的质量改进研究中，NHCC网站严重伤害福尔斯和压疮的漏报在疗养院中很普遍，与种族和民族组成以外的设施特征有关。白色居民较多的疗养院严重伤害福尔斯的报告率较高，而黑人居民较多的疗养院压疮的报告率较高。这项研究的结果表明，鉴于NHCC网站上普遍漏报2个病人的安全指标在养老院，替代方法来衡量养老院的质量需要考虑。美国政府对养老院进行评级，并在Nursing Home Care Compare（NHCC）网站上报告基本质量措施。这些措施来自设施报告的数据，研究表明，这是大大少报。评估疗养院特征与严重损伤福尔斯和压疮报告之间的相关性，这是NHCC网站报告的3种特定临床结局中的2种。这项质量改进研究使用了2011年1月1日至2017年12月31日期间所有医疗保险按服务收费受益人的住院数据。严重损伤福尔斯和压力性溃疡的住院索赔与疗养院住院医师水平的机构报告的最小数据集（MDS）评估相关。对于每个关联的医院索赔，确定养老院是否报告了事件，并计算报告率。整个养老院的报告和报告和设施特征之间的关联的分布进行了检查。为了评估疗养院在这两项指标上的报告是否相似，估计了疗养院内严重损伤福尔斯和压疮报告之间的相关性，并调查了可能解释观察到的相关性的种族和民族差异。排除了小型设施和研究期间每年未连续纳入样本的设施。所有分析均于二零二二年全年进行。使用了两种疗养院级别的MDS报告率，按长期住院与短期住院人群或按人种和种族分层：跌倒报告率和压疮报告率。样本包括13179家疗养院，其中131000名居民（平均[SD]年龄，81.9 [11.8]岁; 93010名女性[71.0%]; 81.1%为白色人种和种族）经历了严重受伤跌倒或压疮住院治疗。有98669例严重损伤跌倒住院，其中60.0%是报告的，39894例3或4期压疮住院，其中67.7%是报告的。这两种情况的漏报普遍存在，分别有69.9%和71.7%的疗养院的重大损伤跌倒和压疮住院率低于80%。较低的报告率与少数机构特征有关，而不是种族和民族组成。跌倒报告率高与低的设施中白色居民明显更多（86.9%与73.3%），压疮报告率高与低的设施中白色居民明显更少（69.7%与74.9%）。这种模式在疗养院中得到保留，其中2个报告率之间相关性的斜率系数为-0.42（95%CI，-0.68至-0.16）。也就是说，有更多白色居民的养老院有更高的严重伤害福尔斯报告率和更低的压疮报告率。这项研究的结果表明，在美国的养老院严重伤害福尔斯和压力性溃疡的普遍漏报，漏报与种族和民族组成的设施。需要考虑衡量质量的其他方法。
This quality improvement study assesses facility-reported rates of major injury falls and pressure ulcers in nursing homes across the US and investigates whether nursing home characteristics are associated with underreporting of these measures. To what extent are nursing home characteristics associated with reporting rates of major injury falls and pressure ulcers on the Nursing Home Care Compare (NHCC) website? In this quality improvement study involving 13 179 nursing homes, underreporting of major injury falls and pressure ulcers to the NHCC website was widespread across nursing homes and was associated with few facility characteristics other than racial and ethnic composition. Nursing homes with more White residents had high reporting rates for major injury falls, whereas facilities with more Black residents had higher reporting rates for pressure ulcers. The findings of this study suggest that given the widespread underreporting on the NHCC website of 2 patient safety indicators across nursing homes, alternative approaches to measuring nursing home quality need to be considered. The US government rates nursing homes and reports the underlying quality measures on the Nursing Home Care Compare (NHCC) website. These measures are derived from facility-reported data, which research indicates to be substantially underreported. To assess the association between nursing home characteristics and reporting of major injury falls and pressure ulcers, which are 2 of 3 specific clinical outcomes reported by the NHCC website. This quality improvement study used hospitalization data for all Medicare fee-for-service beneficiaries between January 1, 2011, and December 31, 2017. Hospital admission claims for major injury falls and pressure ulcers were linked with facility-reported Minimum Data Set (MDS) assessments at the nursing home resident level. For each linked hospital claim, whether the nursing home had reported the event was determined and reporting rates were computed. The distribution of reporting across nursing homes and the associations between reporting and facility characteristics were examined. To assess whether nursing homes reported similarly on both measures, the association between reporting of major injury falls and pressure ulcers within a nursing home was estimated, and racial and ethnic disparities that might explain the observed associations were investigated. Small facilities and those that were not included in the sample continuously in each year of the study period were excluded. All analyses were performed throughout 2022. Two nursing home–level MDS reporting rates, stratified by long-stay vs short-stay population or by race and ethnicity, were used: fall reporting rate and pressure ulcer reporting rate. The sample included 13 179 nursing homes where 131 000 residents (mean [SD] age, 81.9 [11.8] years; 93 010 females [71.0%]; 81.1% with White race and ethnicity) experienced major injury fall or pressure ulcer hospitalizations. There were 98 669 major injury fall hospitalizations, of which 60.0% were reported, and 39 894 stage 3 or 4 pressure ulcer hospitalizations, of which 67.7% were reported. Underreporting for both conditions was widespread, with 69.9% and 71.7% of nursing homes having reporting rates less than 80% for major injury fall and pressure ulcer hospitalizations, respectively. Lower reporting rates were associated with few facility characteristics other than racial and ethnic composition. Facilities with high vs low fall reporting rates had significantly more White residents (86.9% vs 73.3%), and facilities with high vs low pressure ulcer reporting rates had significantly fewer White residents (69.7% vs 74.9%). This pattern was retained within nursing homes, where the slope coefficient for the association between the 2 reporting rates was −0.42 (95% CI, –0.68 to –0.16). That is, nursing homes with more White residents had higher reporting rates for major injury falls and lower reporting rates for pressure ulcers. Results of this study suggest widespread underreporting of major injury falls and pressure ulcers across US nursing homes, and underreporting was associated with the racial and ethnic composition of a facility. Alternative approaches to measuring quality need to be considered.
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