Hogan Tory H, Maurer Nicholas R, Noghrehchi Pejmon, Hearld Larry R
The Division of Health Services Management and Policy, College of Public Health, Ohio State University, Columbus, OH, USA.
Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
J Am Med Dir Assoc. 2025 Jul;26(7):105631. doi: 10.1016/j.jamda.2025.105631. Epub 2025 Jun 3.
Nursing Home Compare star ratings are closely watched by hospital delivery systems, policymakers, and consumers as measures of care quality. However, very little is known about the degree to which nursing homes can or do move between star ratings, what we refer to as performance mobility. This study addresses a gap in the literature by examining mobility trends in overall nursing home star ratings.
Descriptive analysis.
We reviewed 2,016,985 monthly ratings for 16,568 unique US Medicare-certified nursing homes.
Using Centers for Medicare and Medicaid Services (CMS) Nursing Home Compare data, we constructed a database of the overall monthly star ratings for each nursing home in the United States from January 2009 through February 2020. We began by trending the proportion of nursing homes receiving each rating over time before proceeding to 3 focused analyses on mobility, including (1) the frequency of mobility, (2) the median transition time for each mobility combination, and (3) trends in single-unit changes in rating.
From 2009 to 2020, we observed a general upward trend in overall ratings despite stricter quality requirements, and frequent mobility-both upward and downward-between ratings: 40.32% of 1-star nursing homes later received a 5-star rating, whereas 27.97% of 5-star nursing homes later received a 1-star rating. When these changes between extremes occurred, they took an average of <5 years.
Our findings suggest that nursing home 5-star ratings change frequently and quickly. Performance plays a key role in nursing home selection among patients, and our results suggest that further studies should examine the antecedents and impacts of such changes.
疗养院比较星级评定作为护理质量的衡量标准，受到医院分娩系统、政策制定者和消费者的密切关注。然而，对于疗养院在星级评定之间能够或实际发生变动的程度（即我们所说的绩效流动性），人们知之甚少。本研究通过考察疗养院总体星级评定的流动性趋势，填补了文献中的这一空白。
描述性分析。
我们回顾了16568家美国医疗保险认证的独特疗养院的2016985个月度评定。
利用医疗保险和医疗补助服务中心（CMS）的疗养院比较数据，我们构建了一个数据库，记录了2009年1月至2020年2月期间美国每家疗养院的总体月度星级评定。我们首先对随时间推移获得各评定等级的疗养院比例进行趋势分析，然后进行三项关于流动性的重点分析，包括（1）流动性频率，（2）每种流动性组合的中位过渡时间，以及（3）评级单项变化趋势。
从2009年到2020年，尽管质量要求更加严格，但我们观察到总体评级呈普遍上升趋势，且评级之间频繁出现上下波动：1星级疗养院中有40.32%后来获得了5星级评定，而5星级疗养院中有27.97%后来获得了1星级评定。当这些极端之间的变化发生时，平均用时不到5年。
我们的研究结果表明，疗养院的5星级评定频繁且迅速变化。绩效在患者选择疗养院中起着关键作用，我们的结果表明，进一步的研究应考察此类变化的前因后果及影响。
