Changes to nursing home quality ratings system caused consumers to choose better providers
By a
It has been a difficult problem in health economics and policy whether public reporting of quality information actually works in the absence of experimental data.
Perraillon, lead author and a professor in the
The main problem, researchers say, is that no control group exists to help evaluate the effectiveness of the policy, which is intended to help people choose the best providers by improving the quality and accessibility of information about nursing homes and other providers. The authors used a statistical method called regression continuity to show that consumers are indeed using the data to inform better decisions about care.
"At face value, it seems reasonable that consumers or their families will respond by choosing providers (hospitals, nursing homes, etc.) of better quality," Perraillon said. "That's the purpose of the policy, since it creates incentives for providers to improve quality of care, but this has been hard to prove."
In a regression discontinuity study design, participants are assigned to a comparison group on the basis of a cutoff score on a quality measure. Health economists used this design to estimate changes in new nursing home admissions six months after the publication of the new ratings, which went into effect in 2008.
Their results also show that nursing homes that obtained an additional star on the one-to-five scale gained more admissions. They also identified that not all consumers responded to the change the same way, including low-rated nursing homes providing service in poorer areas which take mostly Medicaid patients.
"Disparities in quality of care and access is an ongoing problem in the nursing home market. Our results suggest that potential patients of lower rated nursing homes have fewer choices and they not benefit from ratings. In fact, ratings could lead to even more disparities," Perraillon said. "These nursing homes tend to be crowded already so managers don't care much about their ratings. Poorer patients don't have a lot of options."
Researchers conclude that the form of quality reporting matters to consumers and that the increased use of composite ratings like the five-star system is likely to cause more people to use the system to compare and choose providers that better fit their needs.
"Consumer Response to Composite Ratings of Nursing Home Quality," was published
Keywords for this news article include: Public Health, Quality of Care, Health and Medicine, Finance and Investment,
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