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Impact of Public Reporting on Quality of Postacute Care

Authors

  • Rachel M. Werner,

    1. Center for Health Equity Research and Promotion, Philadelphia VAMC, the Division of General Internal Medicine, University of Pennsylvania School of Medicine, and the Leonard Davis Institute of Health Economics, University of Pennsylvania
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    • Address correspondence to Rachel M. Werner, M.D., Ph.D., 1230 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104; e-mail: rwerner@mail.med.upenn.edu. Rachel Werner is with the Center for Health Equity Research and Promotion, Philadelphia VAMC, the Division of General Internal Medicine, University of Pennsylvania School of Medicine, and the Leonard Davis Institute of Health Economics, University of Pennsylvania. R. Tamara Konetzka, Ph.D., is with the Department of Health Studies, University of Chicago, Chicago, IL. Elizabeth A. Stuart, Ph.D., is with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Edward C. Norton, Ph.D., is with the Department of Health Management and Policy and Department of Economics, University of Michigan, Ann Arbor, MI. Daniel Polsky, Ph.D., is with the Division of General Internal Medicine, University of Pennsylvania School of Medicine, and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA. Jeongyoung Park is with the Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA.

  • R. Tamara Konetzka,

    1. Department of Health Studies, University of Chicago, Chicago, IL
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  • Elizabeth A. Stuart,

    1. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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  • Edward C. Norton,

    1. Department of Health Management and Policy and Department of Economics, University of Michigan, Ann Arbor, MI
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  • Daniel Polsky,

    1. University of Pennsylvania School of Medicine, and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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  • Jeongyoung Park

    1. University of Pennsylvania School of Medicine, Philadelphia, PA.
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Abstract

Objective. Evidence supporting the use of public reporting of quality information to improve health care quality is mixed. While public reporting may improve reported quality, its effect on quality of care more broadly is uncertain. This study tests whether public reporting in the setting of nursing homes resulted in improvement of reported and broader but unreported quality of postacute care.

Data Sources/Study Setting. 1999–2005 nursing home Minimum Data Set and inpatient Medicare claims.

Study Design. We examined changes in postacute care quality in U.S. nursing homes in response to the initiation of public reporting on the Centers for Medicare and Medicaid Services website, Nursing Home Compare. We used small nursing homes that were not subject to public reporting as a contemporaneous control and also controlled for patient selection into nursing homes. Postacute care quality was measured using three publicly reported clinical quality measures and 30-day potentially preventable rehospitalization rates, an unreported measure of quality.

Principal Findings. Reported quality of postacute care improved after the initiation of public reporting for two of the three reported quality measures used in Nursing Home Compare. However, rates of potentially preventable rehospitalization did not significantly improve and, in some cases, worsened.

Conclusions. Public reporting of nursing home quality was associated with an improvement in most postacute care performance measures but not in the broader measure of rehospitalization.

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