Nursing Homes Response to Quality Indictors Publication

描述（由申请人提供）：尽管进行了改革和加强监管，但长期以来，人们一直认为国内许多养老院的护理质量不足。最近一项旨在提高质量的CMS政策倡议依赖于养老院质量报告卡的出版，这使得患者可以轻松地比较竞争养老院的相对质量排名。预计印发这种报告卡将为护理机构提供积极的激励，以提高其提供的护理质量。然而，报告卡也可能导致养老院采取“功能失调”的策略，比如“略读奶油”或“应试教学”。这种策略可能会对养老院护理的质量和获得产生不利影响。一般来说，关于卫生保健组织，特别是养老院对这种报告卡的反应的经验证据是缺乏和不确定的。在建议的研究中，我们将调查养老院对CMS质量报告卡的反应，并回答两个问题：1)哪些因素决定了养老院在回应质量报告时采取的策略？2)这些策略对质量的影响是什么？

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.