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Impact of Voluntary Accreditation on Short-Stay Rehabilitative Measures in U.S. Nursing Homes


  • Laura M. Wagner PhD, RN,

    Corresponding author
    • Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
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  • Shawna M. McDonald MSc,

    1. Department of Health Policy, Management, and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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  • Nicholas G. Castle PhD

    1. Department of Health Policy & Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Laura M. Wagner, PhD, RN, Assistant Professor, University of California, San Francisco, School of Nursing, Department of Community Health Systems, 2 Koret Way, Rm 511R, San Francisco, CA 94143.




To examine accreditation from nursing homes accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) and whether this is associated with improved rehabilitation care.


Cross-sectional association of CARF accreditation and quality.


Comparison of the short-stay quality measures (influenza and pneumococcal vaccination; pain; delirium; pressures sores; five-star quality and health inspection scores) between the sample of 246 CARF-accredited homes compared with the 15,393 nursing homes in the 2010 On-Line Survey Certification of Automated Records (OSCAR).


CARF-accredited nursing homes demonstrate better quality with regard to the short-stay quality measures.


Approaches beyond traditional regulation and governmental inspections are necessary to improve the quality of care in nursing homes.

Clinical Relevance

During a patient's rehabilitation stay, minimizing iatrogenic complications is paramount. Given the findings of this study, it is unfortunate that very few nursing homes are CARF accredited.