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To what degree does provider performance affect a quality indicator? The case of nursing homes and ADL change
- Authors:
- PHILLIPS Charles D., CHEN Min, SHERMAN Michael
- Journal article citation:
- Gerontologist, 48(3), June 2008, pp.330-337.
- Publisher:
- Oxford University Press
This research investigates what factors affect the degree to which nursing home performance explains variance in residents' change in status of activities of daily living (ADL) after admission. The database included all residents admitted in 2002 to a 10% random sample of nursing homes in the United States. Longitudinal analyses of outcomes at 3 months after admission test the ability of individual characteristics and nursing home identifiers to explain variance in ADL change for different groups of residents. The best and worst providers (top 20% vs bottom 20%, then 10%, then 5%) were compared. Analyses was restricted to more homogeneous groups of residents. It was found that more of the variance in ADL change was attributable to provider performance. Cognitive function and race also affected the degree to which home performance had an impact on outcomes. The results imply that some quality indicators may be most useful in distinguishing between nursing homes that provide the best or the worst care. Furthermore, the degree to which a quality indicator is driven by a nursing home's performance may vary considerably, depending on the characteristics of the consumer. These findings raise questions about the usefulness of performance measures that focus on heterogeneous groups of consumers or entire provider populations.
Evaluating nursing home performance indicators: an illustration exploring the impact of facilities on ADL change
- Authors:
- PHILLIPS Charles D., et al
- Journal article citation:
- Gerontologist, 47(5), October 2007, pp.683-689.
- Publisher:
- Oxford University Press
Performance measurement systems for nursing homes assume that facility performance contributes heavily to individual outcomes. This American research illustrates how that assumption can be assessed using the change in residents' activities of daily living (ADLs). The data used in these analyses were all from residents with both an admission and a quarterly assessment in a sample of all admissions to a randomly chosen 10% of Medicare- or Medicaid-certified nursing homes operating during 2002. Models including both facility and individual variables explained up to 20% of the variation in ADL change after admission. Facility identity in isolation explained between 8% and 14% of the variation in ADL change. The results suggest that quality indicators based on change in ADLs may be problematic when used in nursing home performance measurement systems. More generally, the results recommend that the level of variation in performance measures attributable to facility identity or performance become a much more central consideration when researchers evaluate quality indicators for use in nursing home performance measurement systems.