Factors influencing nursing home response to quality measure publication: A resource dependence perspective

The Centers for Medicare and Medicaid Services provides a report card on nursing homes at a Web site called Nursing Home Compare (NHC) that includes information on 19 clinical quality measures (QMs). The information is intended to inform consumer choice, to provide a focus for state regulatory initiatives, and to promote nursing home quality improvement efforts.

This study aimed to determine what factors were associated with nursing homes' investment in quality after publication of the NHC report card.

A 2007 survey sent to nursing home administrators nationally inquired about their response to publication of QMs on NHC. Survey data were merged with data on QMs and organizational characteristics from NHC. The dependent variables represent actions requiring a significant investment of resources in staffing and/or equipment. Independent variables tested hypotheses regarding the influence of constituent groups, competition, and managed care participation on investment. We estimated logistic regression models adjusting for clustering within states.

The degree to which nursing homes perceive that the report card influences key constituencies (professional referral sources, consumers, and state surveyors) is associated with the odds of committing substantial resources to improve report card performance. Facilities with lower reported QM scores were three times more likely to make certain investments than high-quality facilities in competitive markets. Perceived QM validity and close monitoring of scores also motivates investment.

A substantial proportion of nursing homes now perceive that the report card influences professional referrals, consumer choice, and state survey investigatory process. This suggests that QM publication may indeed have a competitive impact as it concerns these constituencies, thus increasing the stakes in improving the scores and making substantial investments much more likely.