![]() It also creates summaries of these by assigning stars to each home through the Five-Star Quality Rating System. 2 Today, NHC reports nursing home performance on several patient safety indicators, among other measures for staffing and inspections. 1 Since the 1990s, a centerpiece of federal efforts to improve nursing home quality has been a public reporting initiative by the Centers for Medicare and Medicaid Services (CMS) called Nursing Home Compare (NHC). In 1987, a landmark Institute of Medicine report concluded that the quality of care in many nursing homes was seriously inadequate. ![]() The data Nursing Home Compare uses for reporting patient safety related to falls may be highly inaccurate. Section 2: We focused on the falls section of the nursing home-reported data and found only 57.5 percent of major injury falls, identified in claims data, were reported, and that reporting was substantially lower for nonwhite people than white people.The accuracy of these data has long been a concern to academics and policy makers, based on inconsistencies with measures from other sources and small validation exercises. Section 1: The federal website Nursing Home Compare reports patient safety measures for nursing homes using data that are self-reported by nursing homes.The nursing home-reported data used for the NHC falls measure may be highly inaccurate. The correlation between fall rates based on claims vs the MDS was 0.22. Adjusting for facility-level race differences, reporting was lower for nonwhite people than white people holding constant patient race, having larger proportions of nonwhite people in a nursing home was associated with lower reporting. Reporting was higher for long-stay (62.9 percent) than short-stay (47.2 percent), and for white (59.0 percent) than nonwhite residents (46.4 percent). For the MDS item used by NHC, only 57.5 percent were reported. We identified 150,828 major injury falls in claims that occurred during nursing home residency. We created a claims-based major injury fall rate for each nursing home and estimated its correlation with Nursing Home Compare (NHC) measures. Using multilevel modeling, we assessed patient and nursing home characteristics that may be predictive of poor reporting. The proportion of claims-identified falls reported for each fall-related MDS item was calculated. We linked inpatient claims for major injury falls with MDS assessments. MDS assessments and Medicare claims, 2011-2015. For a high level-breakdown, read on.To assess the accuracy of nursing home self-report of major injury falls on the Minimum Data Set (MDS). If the measure is Risk Adjusted, the basic (observed) percentage will be adjusted.įor extra details on the measures, see the detailed specifications on CMS’s website. ![]() For example, a QM measuring mobility improvement will be adjusted for the resident’s age.Īll measures are calculated as percentages, with “triggering” residents serving as the numerator, and a set of qualifying residents serving as the denominator. ![]() This means that some residents may be more or less predisposed to the condition that the QM measures. Claims-based QMs are calculated based on Medicare claim data submitted by the facility on a well after care has been delivered, so these measures often have a lag time of a year or more.įinally, some measures are Risk Adjusted. MDS-based measures are calculated from Minimum Data Set (MDS) Assessments, or surveys of resident health, that get submitted to CMS each quarter. In addition, QMs can be either MDS-based, or claims-based. Short Stay residents are typically in the facility briefly for rehab while Long Stay residents are expected to remain in the facility. Nursing Home Quality Star Rating Measures are divided into two major sections – Short Stay and Long Stay.
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