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Providing Outcomes Information to Nursing Homes: Can It Improve Quality of Care?

Correspondence: Address correspondence to Nicholas G. Castle, PhD, RAND, 201 North Craig Street, Suite 102, Pittsburgh, PA 15213-1516. E-mail: CASTLE{at}RAND.org

Purpose: This study examined whether providing outcomes information to 120 nursing homes facilitated improvements in quality over a 12-month period, as compared with 1,171 facilities not receiving this information. The outcomes information provided consisted of a report mailed to administrators that examined six measures of care quality. These were the rates of physical restraint use, urethral catheterization, contractures, pressure ulcers, psychotropic medication use, and certification survey quality of care deficiencies. Design and Methods: Data used in this investigation came from the 1998 and 1999 On-line Survey, Certification and Recording (OSCAR) system. With the use of generalized least squares regression and each of the six quality indicators as dependent variables, risk-adjustment models were developed by using aggregate resident variables as independent variables. These risk-adjustment models were used to compare the outcome measures for the intervention facilities with the same outcome measures in other facilities in the same states (Kansas, Maine, Mississippi, New York, Texas, and South Dakota). The difference between 1998 predicted scores less actual scores was calculated, and the difference between 1999 predicted scores less actual scores for each facility was calculated. Subtracting these 1998 difference scores from the 1999 difference scores gives some indication of the change in outcomes controlling for resident mix. Results: Physical restraint use and psychotropic medication use were significantly lower after 12 months in the intervention facilities, suggesting that quality had improved. Implications: This study may provide evidence that some of the outcomes initiatives currently being pursued in the long-term care arena will positively affect quality of care.

Key Words: Quality • Outcomes • OSCAR

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