Accuracy of U.S. Nursing Home Quality Measures

A central feature of the U.S. government’s strategy to monitor and improve nursing home care is public reporting of facility-level quality indicators and star ratings. However, these indicators are mostly based on unverified nursing home-reported data. We assessed the accuracy of four key patient safety measures - the rates of major injury falls, pressure ulcers, urinary traction infections, and pneumonia - by comparing nursing home-reported data against hospitalizations. In all four measures, we found substantial underreporting, with variation by individual race and nursing home race mix. We also investigated the distributions of reporting, correlations between hospital-based rates and publicly reported measures, and nursing home characteristics that may be predictive of underreporting. Our findings indicate alternative approaches are needed to improve surveillance of nursing home quality. The U.S. experience may be valuable for other countries considering public reporting as an approach to increasing competition and improving quality of care.