Brief Report| Volume 22, ISSUE 3, P706-711.e4, March 2021

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A Rising Tide Lifts “Related” Boats—Post-Acute Care Quality Improvement is Associated With Improvement in Long-Term Care Quality in Nursing Homes

Published:November 22, 2020DOI:



      To examine the relationship between post-acute care (PAC) quality improvement and long-term care (LTC) quality changes.


      Observational study using national nursing home data from Nursing Home Compare linked to Brown University's LTCFocus data.

      Setting and Participants

      Free-standing nursing homes serving PAC and LTC residents in the United States.


      This study used pooled cross-sectional analysis with nursing home–level data from 2005 to 2010 (12,150 unique nursing homes). We used fixed effects models to examine the association between a 1-year change in PAC quality and a 1-year change in LTC quality, with a specific focus on related care domains.


      Strong and positive associations were found between related PAC and LTC care domains, particularly between the PAC and LTC influenza vaccination care domains (β = 0.30, P < .001) and the PAC and LTC pneumococcal vaccination care domains (β = 0.55, P < .001). Meanwhile, model results showed PAC quality changes essentially had no associations with unrelated LTC care domains.

      Conclusions and Implications

      This is the first study that examines the association of changes in quality between 2 overlapping but different care domains (ie, PAC and LTC) using multiple quality measures. Our findings indicate that nursing homes can manage concurrent quality improvement in PAC and LTC, particularly on care domains that are related. More research is needed to examine the mechanism that enables such concurrent quality improvement.


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