The Role of Dementia in Nursing Home Report Cards

In Medical Care Research and Review, R. Tamara Konetzka and colleagues, including Rachel Werner, explore the intended and unintended effects of quality reporting for nursing home residents with severe dementia relative to other residents. Selected quality measures are examined using a difference-in-difference design. The authors find that before public reporting, nursing home residents with severe dementia scored worse on most reported quality measures, such as physical restraint use and worsening of activities of daily living. After public reporting was launched (Nursing Home Compare), outcomes for residents with severe dementia did not consistently improve or worsen, and differences by dementia status persisted. Despite the potential negative impact on quality scores, there was no evidence that nursing homes are avoiding individuals with severe dementia. However, the authors find a significant increase in coding of end-stage disease, which might remove patients with severe dementia from the reporting pool. Additional risk-adjustment, stratification of outcomes, or additional quality measures may be warranted to better capture the quality of care experienced by nursing home residents with severe dementia.