Nursing Homes Response to Quality Indictors Publication

描述(由申请人提供)：尽管努力改革和加强监管，但美国许多养老院的护理质量长期以来一直被认为是不够的。最近一项旨在提高质量的CMS政策倡议依赖于疗养院质量成绩单的发布，这使得患者可以轻松地比较竞争对手疗养院的相对质量排名。预计这种成绩单的公布将为护理机构提供积极的激励措施，以提高它们提供的护理质量。然而，成绩单也可能导致养老院采取“失灵”策略，如“撇奶油”或“教给测试”。这种策略可能会对疗养院护理的质量和获得机会产生不利影响。关于一般卫生保健组织，特别是养老院对这种成绩单的反应的经验证据很少，也没有定论。在这项拟议的研究中，我们将考察养老院对CMS质量报告卡发布的反应，并将回答两个问题：1)哪些因素决定养老院对质量报告采取哪些策略？2)这些策略对质量的影响是什么？ 这项拟议的研究将比较报告发布前一段时间的数据和发布后一段时间的数据，以检查养老院行为的变化。我们将创建一个全面的数据集，其中包含以下信息：1)养老院在发布质量报告卡后采取的策略及其对质量报告卡的看法(基于对养老院的全国调查)，2)报告发布前后的质量，包括报告中发布的报告，其他未发布的报告，以及酒店质量(基于MDS数据与联邦医疗保险登记数据和从养老院成本报告获得的资源使用数据合并)，以及3)入院概况变化的信息(MDS数据)。统计回归技术将被用来分析数据和检验特定的假设。

DESCRIPTION (provided by applicant): Quality of care in many of the nation's nursing homes has been long recognized as inadequate despite efforts to reform and strengthen regulations. A more recent CMS policy initiative designed to improve quality relies on publication of nursing home quality report cards, which allow patients to easily compare relative quality ranking of competing nursing homes. Publication of such report cards is expected to provide nursing facilities with positive incentives to improve the quality of care they offer. Report cards may, however, also lead nursing homes to adopt "dysfunctional" strategies, such as "cream skimming" or "teaching to the test". Such strategies may adversely affect quality and access to nursing home care. The empirical evidence about the response of health care organizations in general, and nursing homes in particular, to such report cards is scant and inconclusive. In the proposed study we will examine the response of nursing homes to the publication of the CMS quality report cards and will answer two questions: 1) What factors determine which strategies nursing homes adopt in response to quality reports? And 2) what is the impact of such strategies on quality? The proposed study will compare data from the period prior to publication of the report to data from a period following publication to examine changes in behavior of nursing homes. We will create a comprehensive data set with information about: 1) the strategies that nursing homes adopted following publication and their views of the quality report cards (based on a national survey of nursing homes), 2) quality before and after publication of the reports measured along different dimensions, including those published in the reports, others that are not published, and hotel quality (based on MDS data merged with Medicare enrollment data and data on resource use obtained from nursing home cost reports) and 3) information about changes in admission profiles (MDS data). Statistical regression techniques will be used to analyze the data and test specific hypotheses.