A National-Level Analysis of the Relationship Between Nursing Home Satisfaction and Quality

Nadash, Pamela; Hefele, Jennifer Gaudet; Barooah, Adrita; Wang, Xiao Joyce

doi:10.1177/0164027518805001

Cited by 13 publications

(6 citation statements)

References 55 publications

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“…9,[17][18][19] The US Government Accountability Office recommended in 2016 that CMS evaluate the feasibility of adding consumer satisfaction survey results to the Five-Star system, 8 in line with studies that have found satisfaction surveys measure unique dimensions of nursing home quality. 20,21 Numerous surveys have been developed to measure nursing home satisfaction, though many are lengthy and/or not publicly available, 22 with the exception of some states' mandated surveys (eg, Minnesota, Ohio). [21][22][23] As another way to augment the star ratings, a consumer-based measure of quality has been studied, with evidence indicating consumers place value on several nontechnical dimensions (eg, attentiveness to residents, physical environment) not captured in the Five-Star system ratings.…”

Section: Discussionmentioning

confidence: 99%

“…The US Government Accountability Office recommended in 2016 that CMS evaluate the feasibility of adding consumer satisfaction survey results to the Five-Star system, in line with studies that have found satisfaction surveys measure unique dimensions of nursing home quality . Numerous surveys have been developed to measure nursing home satisfaction, though many are lengthy and/or not publicly available, with the exception of some states’ mandated surveys (eg, Minnesota, Ohio) .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Assessment of Consumer Complaint Investigation Scores, Recertification Survey Scores, and Overall Nursing Home Health Inspection Star Quality Rating

Peterson

Bowblis

2023

JAMA Netw Open

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ImportanceThe Centers for Medicare &amp; Medicaid Services’ Five-Star Quality Rating System combines results from nursing home recertification surveys and complaint investigations into a single indicator for health inspections. This combination may mask complaint investigation results.ObjectiveTo construct and compare star ratings specific to recertification surveys and specific to complaint investigations to discern whether they provide different information.Design, Setting, and ParticipantsIn this quality improvement study, the Nursing Home Compare Five-Star Quality Rating System was used to calculate three 5-star ratings: 1 overall health inspection rating combining recertification survey scores and complaint investigation scores, 1 using only recertification scores, and 1 using only complaint investigation scores. The study included US nursing homes. The sample calculated star ratings for nursing homes in November 2017. This sample included all whose most recent recertification surveys occurred in 2016 up to and including November 2017, and those with 36 months of data from the ASPEN Complaints/Incidents Tracking System and the Certification and Survey Provider Enhanced Reports. Data analyses were completed on different days in 2022, depending on which questions were being addressed.Main Outcomes and MeasuresComparison of the 3 star rating distributions. The recertification survey and complaint investigation star ratings were compared with respect to the overall health investigation rating. The recertification and complaint star ratings were cross-tabulated.ResultsAmong the 15 499 nursing homes, 19.8% had 1 overall health inspection star, 23.2% had 2, 23.2% had 3, 23.2% had 4, and 9.8% had 5 overall health inspection stars. Most had the same overall and recertification star ratings; for example, 79.4% had 5 overall stars and 5 recertification survey stars. However, overall and complaint-based star ratings were discordant, with a relatively large proportion of nursing homes (25.7%) having no complaint deficiencies and therefore high star ratings.Conclusions and RelevanceIn this quality improvement study assessing the 2 components of the Five-Star Quality Rating System, results of recertification surveys were largely similar to health inspection star ratings. However, recertification survey scores differed from complaint inspection scores, suggesting health inspection ratings may not reflect consumers’ views of care, services, or other valued amenities. A complaint-focused metric may have utility. However, research is needed concerning the many nursing homes with no or very few complaint deficiencies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Assessment of Consumer Complaint Investigation Scores, Recertification Survey Scores, and Overall Nursing Home Health Inspection Star Quality Rating

Peterson

Bowblis

2023

JAMA Netw Open

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“…These tensions also highlight the need to expand NHC to include a domain related to consumer experience (i.e., resident and family satisfaction or resident quality of life), information study respondents suggested is needed and that prior research has established would be useful to consumers (Hefele et al, 2016;Konetzka & Perraillon, 2016). Recent research showing little correlation between consumers' assessments of NH quality and NHC ratings (Johari et al, 2018;Nadash et al, 2019) further substantiates the need for consumer-reported information on facility quality as a separate, complementary domain on NHC.…”

Section: Discussionmentioning

confidence: 99%

Inside the Black Box of Improving on Nursing Home Quality Measures

et al. 2020

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Nursing Home Compare (NHC) reports quality measures (QMs) for nursing homes (NHs) as part of its 5-star rating system. Most of the QMs are based on facility self-reported data, prompting questions about their validity. To better understand how NHs interact with the QMs, we used qualitative methods, including semistructured interviews with NH personnel ( n = 110), NH provider association representatives ( n = 23), and observations of organizational processes in 12 NHs in three states. We found that most NHs are working to improve the quality of care they provide, not merely their QM scores. However, our interviews and observations revealed limitations with the QMs, suggesting that the QMs—on their own—may not accurately reflect the quality of care NHs provide. Our findings suggest several changes to improve NHC, including adding information related to resident and family experience, providing greater risk adjustment, and providing incentives for NHs that serve socially and medically complex residents.

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“…(125) In contrast, poorly-performing nursing homes "confused staff" with conflicting messages regarding the service's organisational mission and tension between providing resident care and ensuring economic viability. (125) A range of other factors were found to have no clear association with compliance: higher consultation with families (positive (99,118) ; negative (99) ; null (59,77) ); higher consultation with NH residents(positive (118) ; negative (77) ; null (71) ); NHs with a family/resident councils (negative (79) ); NHs that used a satisfaction survey (positive (132) ); higher use of information technology (positive (110,133) ; null (116,134,135) ); higher staff meeting frequency (negative (134) ; null (136) ); administrative/clinical standardisation across a nursing home chain (null (82) ); facility methods for communicating potential IC issues (null (136) ); maintaining a list of service users with infection (null (136) ); and association with other compliant facilities (null (137) ).…”

Section: Network and Communicationsmentioning

confidence: 99%

Determinants of regulatory compliance in health and social care services: a systematic review using the Consolidated Framework for Implementation Research

Dunbar

Keyes

Browne

2022

Preprint

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Background The delivery of high quality care is a fundamental goal for health systems worldwide. One policy tool to ensure quality is the regulation of minimum standards by an independent public authority. This systematic review seeks to identify determinants of compliance with such regulation in health and social care services. Methods Systematic searches were carried out on five electronic databases and grey literature sources. Quantitative, qualitative and mixed methods studies were eligible for inclusion. Titles and abstracts were screened by two reviewers independently. Determinants were identified from the included studies, extracted and allocated to constructs in the Consolidated Framework for Implementation Research (CFIR). The quality of included studies was appraised by two independent reviewers. The results were synthesised in a narrative review using the constructs of the CFIR as grouping themes. Results The search yielded 7,500 articles for screening, of which 157 were included. Most studies were quantitative designs in nursing home settings and were conducted in the United States. We found the following structural characteristics and compliance to be positively associated: smaller facilities (as measured by bed capacity); higher nurse-staffing levels; and lower staff turnover. A facility’s geographic location and compliance was also associated. We make no findings in respect of process determinants as qualitative studies were sparse, limiting investigation of the processes underlying regulatory compliance. Conclusion The literature in this field has focused to date on the structural attributes of compliant providers, perhaps because these are easier to measure, and has neglected more complex processes around the implementation of regulatory standards. A number of gaps, particularly in terms of qualitative work focused on the mechanisms involved in implementing regulations, are evident in the literature and further research in this area is needed to provide a clearer picture.

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A National-Level Analysis of the Relationship Between Nursing Home Satisfaction and Quality

Cited by 13 publications

References 55 publications

Assessment of Consumer Complaint Investigation Scores, Recertification Survey Scores, and Overall Nursing Home Health Inspection Star Quality Rating

Assessment of Consumer Complaint Investigation Scores, Recertification Survey Scores, and Overall Nursing Home Health Inspection Star Quality Rating

Inside the Black Box of Improving on Nursing Home Quality Measures

Determinants of regulatory compliance in health and social care services: a systematic review using the Consolidated Framework for Implementation Research

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