Is a public reporting approach appropriate for nursing home care?
Is a public reporting approach appropriate for nursing home care?
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DOI：
10.1215/03616878-2006-003
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发表时间：
2006-08-01
影响因子：
4.2
通讯作者：
Stevenson, David G.
中科院分区：
文献类型：
--
作者：
Stevenson, David G.
十多年来，宣传质量信息一直被用作急性护理部门的质量改进策略。尽管研究显示这些努力的结果好坏参半，公开报告的质量措施目前正在追求作为一个质量改进战略的养老院。旨在使消费者能够做出明智的选择，并刺激供应商的质量竞争，护理之家的公共报告始于1998年的护理之家比较网站，并在2002年护理之家质量倡议中得到了更大的重视，两者都由联邦政府指导。专注于三个关键的利益相关者群体的反应，跨设置的护理消费者，供应商和购买者，我确定了几个挑战，养老院报告必须克服成功。我的结论是，公开报告的质量措施，养老院将有一个更难的时间比急性护理环境，结果一直令人失望的质量改进。除了概念分析，我评估的质量信息报告的疗养院比较有任何影响疗养院入住率后，其释放。使用前/后发布的设计，我发现，到目前为止，公众报告对养老院入住率的影响微乎其微。虽然一些估计的影响是统计学上显着的，在假设的方向，他们都表明非常小的影响大小。目前还不清楚是否缺乏一个更大的报告效果，以日期是特定的养老院比较或是否固有的更广泛的任务，使用质量信息，以促进养老院护理部门的变化。
Publicizing quality information has been used as a quality improvement strategy in the acute care sector for more than a decade. Despite research showing mixed results of these efforts, publicly reporting quality measures is currently being pursued as a quality improvement strategy for nursing homes. Designed to empower consumers to make informed choices and to stimulate provider competition on quality, nursing home public reporting began in 1998 with the Nursing Home Compare Web site and has received greater emphasis in the 2002 Nursing Home Quality Initiative, both directed by the federal government. Focusing on the response of three key stakeholder groups across settings of care-consumers, providers, and purchasers-I identify several challenges that nursing home reporting must overcome to be successful. I conclude that publicly reporting quality measures for nursing homes will have a harder time promoting quality improvement than for acute care settings, where results have been disappointing thus far. In addition to the conceptual analysis, I evaluate whether the quality information reported on Nursing Home Compare had any impact on nursing home occupancy rates following its release. Using a pre/post-release design, I find that the effect of public reporting on nursing home occupancy rates has been minimal thus far. Although some estimates of effect are statistically significant and in the hypothesized direction, they all suggest very small effect sizes. It is unclear whether the absence of a larger reporting effect to date is specific to Nursing Home Compare or whether it inheres to the broader task of using quality information to promote change in the nursing home care sector.