1. Accuracy of infection reporting in US nursing home ratings
- Author
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Chen, Zihan, Gleason, Lauren J., Konetzka, R. Tamara, and Sanghavi, Prachi
- Subjects
United States. Government Accountability Office ,United States. Department of Health and Human Services. Office of Inspector General ,United States. Centers for Medicare and Medicaid Services ,Urinary tract infections -- Health aspects -- Usage ,Medical research -- Usage -- Health aspects ,Medicine, Experimental -- Usage -- Health aspects ,Bacterial pneumonia -- Health aspects -- Usage ,Medicare -- Usage ,Costs (Law) -- Health aspects -- Usage ,Nursing home patients -- Health aspects -- Usage ,Pneumonia -- Health aspects -- Usage ,Medical care -- Quality management ,Nursing homes -- Usage -- Health aspects ,Business ,Health care industry - Abstract
Objective: To assess the accuracy of nursing home-reported data on urinary tract infections (UTIs), which are publicly reported on Nursing Home Care Compare, and pneumonia, which are not publicly reported. Data Sources and Study Setting: We used secondary data for 100% of Medicare fee-for-service beneficiaries in the United States between 2011 and 2017. Study Design: We identified Medicare fee-for-service beneficiaries who were nursing home residents between 2011 and 2017 and admitted to a hospital with a primary diagnosis of UTI or pneumonia. After linking these hospital claims to resident-level nursing home-reported assessment data in the Minimum Data Set, we calculated the percentages of infections that were appropriately reported and assessed variation by resident- and nursing home-level characteristics. We developed a claims-based nursing home-level measure of hospitalized infections and estimated correlations between this and publicly reported ratings. Data Extraction Methods: Medicare fee-for-service beneficiaries who were nursing home residents and hospitalized for UTI or pneumonia during the study period were included. Principal Findings: Reporting rates were low for both infections (UTI: short-stay residents 29.1% and long-stay residents 19.2%; pneumonia: short-stay residents 66.0% and long-stay residents 70.6%). UTI reporting rates increased when counting additional assessments, but it is unclear whether these reports are for the same versus a newly developed UTI. Black residents had slightly lower reporting rates, as did nursing homes with more Black residents. Correlations between our claims-based measure and publicly reported ratings were poor. Conclusions: UTI and pneumonia were substantially underreported in data used for national public reporting. Alternative approaches are needed to improve surveillance of nursing home quality. KEYWORDS patient safety, pneumonia, public reporting, quality of care, urinary tract infection, 1 | INTRODUCTION Longstanding public concern over the quality of care in US nursing homes (1-10) was intensified by the COVID-19 pandemic, which led to the deaths of over 184,000 [...]
- Published
- 2023
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