Personalizing Nursing Home Compare and the Discharge from Hospitals to Nursing Homes

Abstract

Objective To test whether use of a personalized report card, Nursing Home Compare Plus (NHCPlus), embedded in a reengineered discharge process, can lead to better outcomes than the usual discharge process from hospitals to nursing homes. Data Sources/Setting Primary data collected in the Departments of Medicine and Surgery at a University Medical Center between March 2014 and August 2015. Study Design A randomized controlled trial in which patients in the intervention group were given NHCPlus. Participants included 225 patients or their family members/surrogates. Data Collection Key strokes of NHCPlus users were recorded to obtain information about usage. Users were surveyed about usability and satisfaction with NHCPlus. All participants were surveyed at discharge from the hospital. Survey data were merged with medical records. Principal Findings About 85 percent of users indicated satisfaction with NHCPlus. Compared to controls, intervention patients were more satisfied with the choice process (by 40 percent of the standard deviation p < .01), more likely to go to higher ranked five‐star nursing homes (OR = 1.8, p < .05), traveled to further nursing homes (IRR = 1.27, p < .10), and had shorter hospital stays (IRR = 0.84, p < .05). Conclusions Personalizing report cards and reengineering the discharge process may improve quality and may lower costs compared to the usual discharge process.

Post‐Acute Care After Joint Replacement in Medicare's Bundled Payments for Care Improvement Initiative

“…First, Medicare prohibits hospitals from limiting patients' choice of PAC providers, and while hospitals are allowed to provide information about quality to patients and give them information about preferred partners, many hospital leaders and front‐line discharge personnel are not aware that such “steering” is in fact legal . Of course, even if provided with such information, patients may instead choose PAC providers that are close to their home, recommended by family or friends, or score well on Nursing Home Compare . It is also possible that such networks are time intensive for hospitals to create, and their use may not be reflected in current data; work with longer‐term follow‐up will be important in this regard.…”

Using contingent valuation to develop consumer‐based weights for health quality report cards

“…This research was not designed to answer the question if one set of weights is preferred to another. It was motivated by prior studies, discussed in the introduction, suggesting that consumers may find the expert opinion lacking . And perhaps the best approach, in an era of transparency enabled by current information and web technology, is to offer consumers a choice, of both an “expert‐based” 5‐Star and a “consumer like you” 5‐Star ranking.…”

“…7 A recent California study that elicited preferences from patients and their family members at the time of hospital discharge to NHs suggests that individuals often value quality dimensions differently than the expert-based 5-Star ratings. [8][9][10] However, fully personalizing NH ratings imposes its own cognitive burdens on those selecting NHs. Are there feasible alternative ways to incorporate consumer preferences into decisions about summary scoring?…”

“…Although limited, available evidence suggests a divergence between expert‐based ratings and the preferences of NH residents and family members. An analysis of the Ohio Nursing Home Family satisfaction survey found that “the star rating system does not adequately reflect consumer preferences.” A recent California study that elicited preferences from patients and their family members at the time of hospital discharge to NHs suggests that individuals often value quality dimensions differently than the expert‐based 5‐Star ratings . However, fully personalizing NH ratings imposes its own cognitive burdens on those selecting NHs.…”

Best of the 2016 AcademyHealth Annual Research Meeting

“…Three of the papers focused on the relationship between process improvement and outcomes of care. In a randomized controlled trial, Mukamel et al (2016) found that personalizing nursing home report cards for patients and their caregivers improved satisfaction with the choice process, increased the likelihood of choosing a highly ranked nursing home, and led to shorter hospital stays. Johnston and Hockenberry (2016) found that receiving care from a disease-relevant specialist was associated with lower rates of following-year functional impairment, long-term care institutionalization, and ambulatory care-sensitive hospitalization, among Medicare beneficiaries with diabetes or heart failure.…”