Associations Between Family Ratings on Experience With Care and Clinical Quality-of-Care Measures for Nursing Home Residents

Abstract

Several states are currently collecting and publicly reporting nursing home resident and/or family member ratings of experience with care in an attempt to improve person-centered care in nursing homes. Using the 2008 Maryland nursing home family survey reports and other data, this study performed both facility- and resident-level analyses, and estimated the relationships between family ratings of care and several long-term care quality measures (pressure ulcers, overall and potentially avoidable hospitalizations, and mortality) after adjustment for resident characteristics. We found that better family evaluations of overall and specific aspects of care may be associated with reduced rates of risk-adjusted measures at the facility level (range of correlation coefficients: −.01 to −.31). Associations of overall experience ratings tended to persist after further adjustment for common nursing home characteristics such as nurse staffing levels. We conclude that family ratings of nursing home care complement other types of performance measures such as risk-adjusted outcomes.

Keywords

experience of care pressure ulcers hospitalizations mortality nursing home

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References

Abt Associates. (2004, November). National Nursing Home Quality Measures for National Public Reporting: User’s manual, v1.2. Cambridge, MA: Author.

Berlowitz

D. R.

Wilking

S. V.

(1993). Pressure ulcers in the nursing home. In Rubenstein

L. Z.

Wieland

(Eds.), Improving care in the nursing home: Comprehensive reviews of clinical research (pp. 102-130). Newbury Park, CA: Sage.

Boulding

Glickman

S. W.

Manary

M. P.

Schulman

K. A.

Staelin

(2011). Relationship between patient satisfaction with inpatient care and hospital readmission within 30 days. American Journal of Managed Care, 17(1), 41-48.

Calikoglu

Christmyer

C. S.

Kozlowski

B. U.

(2012). My eyes, your eyes—The relationship between CMS five-star rating of nursing homes and family rating of experience of care in Maryland. Journal of Healthcare Quality, 34(6), 5-12.

Castle

N. G.

(2006). Family members as proxies for satisfaction with nursing home care. Joint Commission Journal on Quality and Patient Safety, 32, 452-458.

Donabedian

(1988). Quality assessment and assurance: Unity of purpose, diversity of means. Inquiry, 25, 173-192.

Elliott

M. N.

Swartz

Adams

Spritzer

K. L.

Hays

R. D.

(2001). Case-mix adjustment of the national CAHPS benchmarking data 1.0: A violation of model assumptions? Health Services Research, 36, 555-573.

Flacker

J. M.

Kiely

D. K.

(2003). Mortality-related factors and 1-year survival in nursing home residents. Journal of the American Geriatrics Society, 51, 213-221.

Frentzel

E. M.

Sangl

J. A.

Evensen

C. T.

Cosenza

Brown

J. A.

Keller

Garfinkel

S. A.

(2012). Giving voice to the vulnerable: The development of a CAHPS nursing home survey measuring family members’ experiences. Medical Care, 50(Suppl.), S20-S27.

10.

Gasquet

Dehe

Gaudebout

Falissard

(2003). Regular visitors are not good substitutes for assessment of elderly patient satisfaction with nursing home care and services. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 58, 1036-1041.

11.

Glickman

S. W.

Boulding

Manary

Staelin

Roe

M. T.

Wolosin

R. J.

. . . Schulman

K. A.

(2010). Patient satisfaction and its relationship with clinical quality and inpatient mortality in acute myocardial infarction. Circulation, 3, 188-195.

12.

Harrington

Olney

Carrillo

Kang

(2012). Nurse staffing and deficiencies in the largest for-profit nursing home chains and chains owned by private equity companies. Health Services Research, 47, 106-128.

13.

Harris-Kojetin

L. D.

Stone

R. I.

(2007). The role of consumer satisfaction in ensuring quality long-term care: Opportunities and challenges. Journal of Aging and Social Policy, 19, 43-61.

14.

Hartman

Martin

A. B.

Benson

Catlin

(2013). National health spending in 2011: Overall growth remains low, but some payers and services show signs of acceleration. Health Affairs (Millwood), 32(1), 87-99.

15.

Institute of Medicine. (1986). Improving the quality of care in nursing homes. Washington, DC: National Academies Press.

16.

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Retrieved from http://www.iom.edu/Reports/2001/Crossing-the-Quality-Chasm-A-New-Health-System-for-the-21st-Century.aspx

17.

Jha

A. K.

Orav

E. J.

Zheng

Epstein

A. M.

(2008). Patients’ perception of hospital care in the United States. New England Journal of Medicine, 359, 1921-1931.

18.

Kane

R. A.

Lum

T. Y.

Cutler

L. J.

Degenholtz

H. B.

T. C.

(2007). Resident outcomes in small-house nursing homes: A longitudinal evaluation of the initial greenhouse program. Journal of the American Geriatrics Society, 55, 832-839.

19.

Koren

M. J.

(2010). Person-centered care for nursing home residents: The culture-change movement. Health Affairs (Millwood), 29, 312-317.

20.

Kozlowski

B. U.

Christmyer

C. S.

(2008, December). Maryland Nursing Home Family Survey. Paper presented at the 11th CAHPS and 1st SOPS User Group Meeting, Scottsdale, AZ.

21.

Cai

Glance

L. G.

Spector

W. D.

Mukamel

D. B.

(2009). National release of the nursing home quality report cards: implications of statistical methodology for risk adjustment. Health Services Research, 44(1), 79-102.

22.

Cai

Glance

L. G.

Harrington

Mukamel

D. B.

(2013). Satisfaction with Massachusetts nursing home care was generally high during 2005-09, with some variability across facilities. Health Affairs (Millwood), 32, 1416-1425.

23.

Harrington

Spector

W. D.

Mukamel

D. B.

(2010). State regulatory enforcement and nursing home termination from the Medicare and Medicaid programs. Health Services Research, 45, 1796-1814.

24.

Glance

L. G.

Temkin-Greener

(2014). Trends in family ratings of experience with care and racial disparities among Maryland nursing homes. Medical Care, 52, 641-648.

25.

Yin

Cai

Temkin-Greener

Mukamel

D. B.

(2011). Association of race and sites of care with pressure ulcers in high-risk nursing home residents. Journal of the American Medical Association, 306, 179-186.

26.

Lucas

J. A.

Levin

C. A.

Lowe

T. J.

Robertson

Akincigil

Sambamoorthi

. . . Crystal

(2007). The relationship between organizational factors and resident satisfaction with nursing home care and life. Journal of Aging and Social Policy, 19, 125-151.

27.

Manary

M. P.

Boulding

Staelin

Glickman

S. W.

(2013). The patient experience and health outcomes. New England Journal of Medicine, 368, 201-203.

28.

Maryland Health Care Commission and Market Decisions, LLC. (2009, March). 2008 Maryland Nursing Facility Family Survey: Statewide report. Baltimore, MA: Author.

29.

Morris

J. N.

Fries

B. E.

Mehr

D. R.

Hawes

Phillips

Mor

Lipsitz

L. A.

(1994). MDS Cognitive Performance Scale. Journal of Gerontology, 49, M174-M182.

30.

Mukamel

D. B.

Weimer

D. L.

Spector

W. D.

Ladd

Zinn

J. S.

(2008). Publication of quality report cards and trends in reported quality measures in nursing homes. Health Services Research, 43 1244-1262.

31.

Olsho

L. E.

Spector

W. D.

Williams

C. S.

Rhodes

Fink

R. V.

Limcangco

Hurd

(2014). Evaluation of AHRQ’s On-Time Pressure Ulcer Prevention Program: A facilitator-assisted clinical decision support intervention for nursing homes. Medical Care, 52, 258-266.

32.

Ouslander

J. G.

Berenson

R. A.

(2011). Reducing unnecessary hospitalizations of nursing home residents. New England Journal of Medicine, 365, 1165-1167.

33.

Ouslander

J. G.

Lamb

Perloe

Givens

J. H.

Kluge

Rutland

. . . Saliba

(2010). Potentially avoidable hospitalizations of nursing home residents: Frequency, causes, and costs. Journal of the American Geriatrics Society, 58, 627-635.

34.

Ouslander

J. G.

Maslow

(2012). Geriatrics and the triple aim: Defining preventable hospitalizations in the long-term care population. Journal of the American Geriatrics Society, 60, 2313-2318.

35.

Rantz

M. J.

Flesner

(2003). Person centered care: A model for nursing homes. Washington DC: American Nurses Association.

36.

Rollow

Lied

T. R.

McGann

Poyer

LaVoie

Kambic

R. T.

. . . Ramunno

L. D.

(2006). Assessment of the Medicare quality improvement organization program. Annals of Internal Medicine, 145, 342-353.

37.

Saliba

Buchanan

(2012). Making the investment count: Revision of the Minimum Data Set for nursing homes, MDS 3.0. Journal of the American Medical Director Association, 13, 602-610.

38.

Sangl

Buchanan

Cosenza

Bernard

Keller

Mitchell

. . . Larwood

(2007). The development of a CAHPS instrument for Nursing Home Residents (NHCAHPS). Journal of Aging and Social Policy, 19(2), 63-82.

39.

Spector

W. D.

Limcangco

Williams

Rhodes

Hurd

(2013). Potentially avoidable hospitalizations for elderly long-stay residents in nursing homes. Medical Care, 51, 673-681.

40.

State Health Facts. (2014). Providers and service use for nursing facilities. Retrieved from www.statehealthfacts.org

41.

Stone

R. I.

Reinhard

S. C.

Bowers

Zimmerman

Philips

C. D.

Hawes

. . . Jacobson

(2002). Evaluation of the Wellspring model for improving nursing home quality. Retrieved from http://www.commonwealthfund.org/Publications/Fund-Reports/2002/Aug/Evaluation-of-the-Wellspring-Model-for-Improving-Nursing-Home-Quality.aspx

42.

Sullivan

J. L.

Shwartz

Burgess

J. F.

Pekoz

E. A.

Christiansen

C. L.

Gerena-Melia

Berlowitz

(2013). Person-centered care practices and quality in Department of Veterans Affairs nursing homes: Is there a relationship? Medical Care, 51, 165-171.

43.

Thomas

W. H.

(1996). Life worth living: How someone you love can still enjoy life in a nursing home: The Eden Alternative in action. St. Louis, MO: Vanderwyk & Burnham.

44.

U.S. Government Accountability Office. (2007). Nursing homes: Efforts to strengthen federal enforcement have not deterred some homes from repeatedly harming residents. Retrieved from http://www.gao.gov/products/GAO-07-241

45.

U.S. Government Accountability Office. (2012). Nursing home quality: CMS should improve efforts to monitor implementation of the Quality Indicator Survey. Retrieved from http://www.gao.gov/products/GAO-12-214

46.

Walsh

E. G.

Freiman

Haber

Bragg

Ouslander

Wiener

J. M.

(2010). Cost drivers for dually eligible beneficiaries: Potentially avoidable hospitalizations from nursing facility, skilled nursing facility, and home and community-based services waiver programs: Final Task 2 report. Washington, DC: Centers for Medicare & Medicaid Services.

47.

Walsh

E. G.

Wiener

J. M.

Haber

Bragg

Freiman

Ouslander

J. G.

(2012). Potentially avoidable hospitalizations of dually eligible Medicare and Medicaid beneficiaries from nursing facility and home- and community-based services waiver programs. Journal of the American Geriatric Society, 60, 821-829.

48.

White

H. K.

Corazzini

Twersky

Buhr

McConnell

Weiner

Colon-Emeric

C. S.

(2012). Prioritizing culture change in nursing homes: Perspectives of residents, staff, and family members. Journal of the American Geriatric Society, 60, 525-531.

49.

Wunderlich

G. S.

Kohler

P. O.

(2001). Improving the quality of care in nursing homes. Washington, DC: National Academies Press.