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• W2034600368 abstract "ver the past 2 decades, there has been significant progress in the measurement of nursing home quality using administrative data. Research in this field has transitioned from facility-level proxies for quality such as staffing1 and government-cited violations2 to resident-level Minimum Data Set (MDS) quality indicators (QIs) such as pressure ulcers3 and the use of antipsychotic medications.4 Despite this progress, several challenges continue to limit the usefulness of available data. First, despite the general perception that quality is substandard in many US nursing homes,5 several key indicators of poor quality are infrequently observed. For instance, the development of a new nursing home-acquired pressure ulcer in a three-month period is a relatively rare event,6 which makes it difficult to construct a meaningful ranking of facilities.7 Second, common sense would suggest that a facility appearing strong in one dimension of quality should also achieve good outcomes across other dimensions of care, but there is a very low correlation across the QIs.8 home quality is undoubtedly a multidimensional construct, but different indicators currently provide conflicting signals. Various measurement issues such as selection and ascertainment bias may contribute to the lack of correlation across measures. Finally, even if the measurement issues can be resolved, there remains the big picture issue of whether increased quality information can lead to a better functioning nursing home market. For example, a series of quality indicators are now published on the Centers for Medicare and Medicaid Services (CMS) Nursing Home Compare website in an effort to use market forces to encourage poorly performing homes to improve quality or face the loss of revenue (US General Accounting Office (GAO), p. 3).9 In this issue of Medical Care, David Stevenson explores nursing home consumer complaints as an alternative pathway to approximate quality.10 Complaints have strong face validity, because they represent direct feedback from consumers (or their surrogates) on what they deem important about their care. Moreover, complaints are easy to interpret, they are available from existing administrative data, and unlike the annual CMS survey and certification process, they provide a current reflection of nursing home quality, because they can be initiated at any time. Somewhat surprisingly, there is virtually no previous research evaluating complaints. Using data from Massachusetts for the period 1998 through 2002, Stevenson's study begins to address this gap in the literature. The results indicate a similar set of challenges to the existing quality measures. First, complaints are submitted infrequently. Second, they do not correlate very well with existing quality indicators and professional staffing, although they do correlate in the expected manner with deficiencies and nurse aide staffing. Finally, their value as a market-based mechanism encouraging better quality outcomes is unclear. Each of these issues is considered in turn below. First, the infrequency of complaints in Massachusetts' nursing homes was striking. Over the course of the study, the average Massachusetts nursing home received 2" @default.
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• W2034600368 date "2005-02-01" @default.
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• W2034600368 title "Consumer Complaints and Nursing Home Quality" @default.
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• W2034600368 doi "https://doi.org/10.1097/00005650-200502000-00002" @default.
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