Evaluating Nursing Home Compare 5-Star Ratings as an Indicator of Skilled Nursing Facility Quality for Veterans

Pilot Project

Evaluating Nursing Home Compare 5-Star Ratings as an Indicator of Skilled Nursing Facility Quality for Veterans

Principal Investigator: Kirstin Manges, PhD
Abstract: There are few ways for patients, hospitals, or health systems to identify Skilled Nursing Facilities (SNF) that provide higher-value care. Although NHCompare is the most widely known quality indicator for nursing homes, little is known about using NHCompare as an indicator for SNF quality. This study will provide critical insight into the extent that the NHCompare 5-star ratings within and outside the VA, are linked to adverse transitional outcomes for older Veterans discharged to SNFs. Specifically we aim to: 1) test the association between NHCompare 5-star ratings with adverse transitional outcomes (death not on hospice, ED visits, hospital readmissions within 7 days of hospital discharge) in Veterans age 65 and older discharged from the hospital to SNF; and 2) compare the association of each of the three main domains of the overall NHCompare 5-star ratings (nurse staffing, inspections, and quality metrics) with adverse transitional outcomes. We included Veterans (≥65 years old) discharged to a SNF following an acute-care hospitalization between January 1, 2012 and December 31, 2014. To test these aims, we propose a retrospective cohort analysis using the Residential History File (a database that combines VA data with Medicare and Medicaid claims) linked with Medicare and VA NHCompare data. Examining to what extent NHCompare is related to actionable adverse transitional outcomes will provide frontline staff, organizations, and researchers with timely information on the appropriateness of using NHCompare as indicators for SNF quality.