The present analysis risk adjusts for variation in the relative complexity of residents in one nursing home compared to another before comparing rates of PPAs and PPVs (without admission), which are specified so as to enable comparison of nursing home care management. 5 The study team is unaware of any other national comparison of the frequency and cause of hospital encounters from nursing homes. 3, 4 The nursing home INTERACT (Interventions to Reduce Acute Care Transfers) program has been piloted to reduce preventable hospitalizations and ED visits without specifying the nature and frequency of those encounters. Previous studies have estimated the volume of ED visits, the acuity of nursing home residents relative to other patients using the ED, and the propensity to be admitted via the ED. The overall Star ranking calculated by the system is dependent on the interplay of 3 domains: (1) reports from health inspectors who make site visits (survey metric) (2) case mix adjusted registered nurse and total nursing staffing hours per resident (staffing metric) and (3) quality scores derived from 16 of the 24 measures posted on the Nursing Home Compare website 2 (quality metric). CMS created the 5-Star Rating System in 2008 as a guide to nursing home performance for patients and families. The study team next evaluates nursing home performance on PPAs and PPVs and their Star rankings assigned by the Centers for Medicare & Medicaid Services (CMS) to assess comparability. The team then calculates 2 important clinical outcomes– risk-adjusted rates of potentially preventable hospital admissions (PPAs) and ED visits (PPVs)–for the residents' nursing homes from a nationwide sample. The study team identifies long-term nursing home residents from within a Medicare fee-for-service (FFS) claims database. Thus, acute care events, such as hospitalizations and emergency department (ED) visits, paid via a separate payer source (Medicare) are monitored infrequently for nursing home quality because of the logistical challenges of matching claims data to residents. 1 Medicare benefits provide coverage for acute medical conditions that affect eligible beneficiaries while other payment sources (primarily Medicaid) are used to pay for the residential care itself. In the United States, 85% of long-term residents of nursing homes are older than 65 years of age and typically qualify for Medicare while the majority of those younger than age 65 typically qualify for Medicare through disability. This is of particular importance for long-term stay residents of nursing homes who are both vulnerable and dependent on the care provided by their residential facilities. T here is considerable national interest in measuring the quality of health care outcomes. Such reform could better help users find nursing homes of higher quality and stimulate homes to improve quality in ways that benefit residents. Nursing Home Compare Star rankings could benefit by incorporating outcomes measures such as preventable hospitalizations and ED visits, and by comparing nursing home performance on results drawn from across states rather than within them. This study found that (1) the likelihood of potentially preventable events increases with increasing burden of chronic illness, (2) the principle reasons for hospital admissions and ED visits (eg, septicemia, pneumonia, confusion, gastroenteritis) are not part of existing nursing home quality measures, (3) the rate of potentially preventable admissions and ED visits for nursing homes residents varies greatly both across and within states, with 5 states having in excess of 20% more than the national average for both, and (4) the Nursing Home Compare Stars measure has limited correlation with rates of these potentially preventable events. The authors determined the rates and types of 2 important clinical outcomes–potentially preventable hospital admissions and potentially preventable emergency department (ED) visits–for a subset of 439,011 long-term nursing homes residents residing in 12,883 nursing homes throughout the United States over a 2-year period (2010–2011) and compared them with the Star Rating system. Nursing Home Compare Star Ratings are provided by Medicare to help select better nursing home care. Measurement of the quality of US health care increasingly emphasizes clinical outcomes over clinical processes.
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