Associations Between Published Quality Ratings of Skilled Nursing Facilities and Outcomes of Medicare Beneficiaries with Heart Failure
Abstract
Introduction
Nursing Home Compare quality ratings are designed to allow patients, families, and clinicians to compare facilities based on quality, but associations of the current measures with important clinical outcomes are not known. Our study examined associations between ratings and readmission and mortality among Medicare beneficiaries admitted to a skilled nursing facility with a primary diagnosis of heart failure.
Methods
We conducted a retrospective cohort study of 164,672 Medicare beneficiaries discharged to skilled nursing facilities after hospitalization for heart failure in 2006–2007. The main outcome measures were readmission and mortality within 90 days.
Results
One-fifth of the 13,619 skilled nursing facilities received a 1-star rating and 11% received a 5-star rating. Nearly half of the patients discharged to a skilled nursing facility were readmitted to a hospital within 90 days after discharge, and 30% died within 90 days. Compared with patients in 5-star skilled nursing facilities, patients in 1-star facilities had higher risks of 90-day readmission (hazard ratio, 1.08) and mortality (1.15). After adjustment for facility size and ownership type, the associations between the quality rating and readmission were not statistically significant, but the associations with mortality were significant.
Conclusion
Publicly reported Nursing Home Compare quality ratings of Medicare-certified skilled nursing facilities were modestly associated with 90-day readmission and mortality among Medicare beneficiaries discharged to these facilities after hospitalization for heart failure.
Keywords: Skilled nursing facilities, Nursing Home Compare, Medicare, patient readmission, mortality, heart failure
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This study was supported by grant 2006–0109 from the John A. Hartford Foundation to the Duke Hartford Center of Excellence at Duke University. The Foundation had no role in the design and conduct of the study; collection, management, and analysis of the data; and preparation, review, and approval of the manuscript. Damon M. Seils, MA, provided editorial assistance and prepared the manuscript. Mr Seils did not receive compensation for his assistance apart from his employment at the institution where the study was conducted.
PII: S1525-8610(11)00167-8
doi:10.1016/j.jamda.2011.04.020
Published by Elsevier Inc.
