Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa.
Department of Economics and Scripps Gerontology Center, Miami University, Oxford, Ohio.
JAMA Netw Open. 2023 Feb 1;6(2):e2253952. doi: 10.1001/jamanetworkopen.2022.53952.
The Centers for Medicare & Medicaid Services' Five-Star Quality Rating System combines results from nursing home recertification surveys and complaint investigations into a single indicator for health inspections. This combination may mask complaint investigation results.
To construct and compare star ratings specific to recertification surveys and specific to complaint investigations to discern whether they provide different information.
DESIGN, SETTING, AND PARTICIPANTS: In this quality improvement study, the Nursing Home Compare Five-Star Quality Rating System was used to calculate three 5-star ratings: 1 overall health inspection rating combining recertification survey scores and complaint investigation scores, 1 using only recertification scores, and 1 using only complaint investigation scores. The study included US nursing homes. The sample calculated star ratings for nursing homes in November 2017. This sample included all whose most recent recertification surveys occurred in 2016 up to and including November 2017, and those with 36 months of data from the ASPEN Complaints/Incidents Tracking System and the Certification and Survey Provider Enhanced Reports. Data analyses were completed on different days in 2022, depending on which questions were being addressed.
Comparison of the 3 star rating distributions. The recertification survey and complaint investigation star ratings were compared with respect to the overall health investigation rating. The recertification and complaint star ratings were cross-tabulated.
Among the 15 499 nursing homes, 19.8% had 1 overall health inspection star, 23.2% had 2, 23.2% had 3, 23.2% had 4, and 9.8% had 5 overall health inspection stars. Most had the same overall and recertification star ratings; for example, 79.4% had 5 overall stars and 5 recertification survey stars. However, overall and complaint-based star ratings were discordant, with a relatively large proportion of nursing homes (25.7%) having no complaint deficiencies and therefore high star ratings.
In this quality improvement study assessing the 2 components of the Five-Star Quality Rating System, results of recertification surveys were largely similar to health inspection star ratings. However, recertification survey scores differed from complaint inspection scores, suggesting health inspection ratings may not reflect consumers' views of care, services, or other valued amenities. A complaint-focused metric may have utility. However, research is needed concerning the many nursing homes with no or very few complaint deficiencies.
医疗保险和医疗补助服务中心的五星质量评级系统将疗养院重新认证调查和投诉调查的结果结合为健康检查的单一指标。这种组合可能掩盖了投诉调查的结果。
构建和比较专门针对重新认证调查和专门针对投诉调查的星级评分，以确定它们是否提供不同的信息。
设计、环境和参与者：在这项质量改进研究中，使用了《疗养院比较五星质量评级系统》来计算三个五星评级：1 个整体健康检查评级，结合重新认证调查评分和投诉调查评分，1 个仅使用重新认证评分，1 个仅使用投诉调查评分。该研究包括美国疗养院。该样本计算了 2017 年 11 月疗养院的星级评分。该样本包括所有在 2016 年及之前最近一次重新认证调查的疗养院，以及在 ASPEN 投诉/事件跟踪系统和认证和调查提供者增强报告中有 36 个月数据的疗养院。数据分析于 2022 年的不同日期完成，具体取决于正在解决的问题。
比较 3 个星级评分分布。重新认证调查和投诉调查星级评分与整体健康调查评分进行了比较。重新认证和投诉星级评分进行了交叉制表。
在 15499 家疗养院中，19.8%有 1 个整体健康检查星级，23.2%有 2 个，23.2%有 3 个，23.2%有 4 个，9.8%有 5 个整体健康检查星级。大多数疗养院的整体和重新认证星级评分相同；例如，79.4%有 5 个整体星级和 5 个重新认证调查星级。然而，整体和基于投诉的星级评分不一致，相对较大比例的疗养院（25.7%）没有投诉缺陷，因此星级评分较高。
在这项评估五星质量评级系统两个组成部分的质量改进研究中，重新认证调查的结果与健康检查星级评分基本相似。然而，重新认证调查评分与投诉检查评分不同，这表明健康检查评分可能无法反映消费者对护理、服务或其他有价值设施的看法。基于投诉的指标可能具有实用性。但是，需要研究许多没有或很少有投诉缺陷的疗养院。
