@article{TEXTUAL,
      recid = {11247},
      author = {Sanghavi, Prachi and Chen, Zihan},
      title = {Underreporting of Quality Measures and Associated Facility  Characteristics and Racial Disparities in US Nursing Home  Ratings},
      journal = {JAMA Network Open},
      address = {2023-05-23},
      number = {TEXTUAL},
      abstract = {&lt;p&gt;Importance: The US government rates nursing homes and  reports the underlying quality measures on the Nursing Home  Care Compare (NHCC) website. These measures are derived  from facility-reported data, which research indicates to be  substantially underreported.&lt;/p&gt; &lt;p&gt;Objective: To assess  the association between nursing home characteristics and  reporting of major injury falls and pressure ulcers, which  are 2 of 3 specific clinical outcomes reported by the NHCC  website.&lt;/p&gt; &lt;p&gt;Design, Setting, and Participants: This  quality improvement study used hospitalization data for all  Medicare fee-for-service beneficiaries between January 1,  2011, and December 31, 2017. Hospital admission claims for  major injury falls and pressure ulcers were linked with  facility-reported Minimum Data Set (MDS) assessments at the  nursing home resident level. For each linked hospital  claim, whether the nursing home had reported the event was  determined and reporting rates were computed. The  distribution of reporting across nursing homes and the  associations between reporting and facility characteristics  were examined. To assess whether nursing homes reported  similarly on both measures, the association between  reporting of major injury falls and pressure ulcers within  a nursing home was estimated, and racial and ethnic  disparities that might explain the observed associations  were investigated. Small facilities and those that were not  included in the sample continuously in each year of the  study period were excluded. All analyses were performed  throughout 2022.&lt;/p&gt; &lt;p&gt;Main Outcomes and Measures: Two  nursing home-level MDS reporting rates, stratified by  long-stay vs short-stay population or by race and  ethnicity, were used: fall reporting rate and pressure  ulcer reporting rate.&lt;/p&gt; &lt;p&gt;Results: The sample included  13 179 nursing homes where 131 000 residents (mean [SD]  age, 81.9 [11.8] years; 93 010 females [71.0%]; 81.1% with  White race and ethnicity) experienced major injury fall or  pressure ulcer hospitalizations. There were 98 669 major  injury fall hospitalizations, of which 60.0% were reported,  and 39 894 stage 3 or 4 pressure ulcer hospitalizations, of  which 67.7% were reported. Underreporting for both  conditions was widespread, with 69.9% and 71.7% of nursing  homes having reporting rates less than 80% for major injury  fall and pressure ulcer hospitalizations, respectively.  Lower reporting rates were associated with few facility  characteristics other than racial and ethnic composition.  Facilities with high vs low fall reporting rates had  significantly more White residents (86.9% vs 73.3%), and  facilities with high vs low pressure ulcer reporting rates  had significantly fewer White residents (69.7% vs 74.9%).  This pattern was retained within nursing homes, where the  slope coefficient for the association between the 2  reporting rates was -0.42 (95% CI, -0.68 to -0.16). That  is, nursing homes with more White residents had higher  reporting rates for major injury falls and lower reporting  rates for pressure ulcers.&lt;/p&gt; &lt;p&gt;Conclusions and  Relevance: Results of this study suggest widespread  underreporting of major injury falls and pressure ulcers  across US nursing homes, and underreporting was associated  with the racial and ethnic composition of a facility.  Alternative approaches to measuring quality need to be  considered.&lt;/p&gt;},
      url = {http://knowledge.uchicago.edu/record/11247},
}