The impact of public reporting on quality of post-acute care

Objective: Evidence supporting the use of public reporting of quality information to improve health care quality is mixed. While public reporting may improve reported quality, its effect on quality of care more broadly is uncertain. This study tests whether public reporting in the setting of nursing homes resulted in improvement of reported and broader but unreported quality of post-acute care. Data Sources/Study Setting: 1999-2005 nursing home Minimum Data Set and inpatient Medicare claims Study Design: We examined changes in post-acute care quality in U.S. nursing homes in response to the initiation of public reporting on the Centers for Medicare and Medicaid Services website, Nursing Home Compare. We used small nursing homes that were not subject to public reporting as a contemporaneous control and also controlled for patient selection into nursing homes. Post-acute care quality was measured using three publicly reported clinical quality measures and 30-day potentially preventable rehospitalization rates, an unreported measure of quality. Principal Findings: Reported quality of post-acute care improved after the initiation of public reporting for 2 of the 3 reported quality measures used in Nursing Home Compare. However, rates of potentially preventable rehospitalization did not significantly improve and, in some cases, worsened. Conclusions: Public reporting of nursing home quality was associated with an improvement in most post-acute care performance measures but not in the broader measure of rehospitalization.