Nursing Home Compare star ratings before versus after a change in nursing home ownership

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY Journal of the American Geriatrics Society Pub Date : 2024-07-29 DOI:10.1111/jgs.19104

Kira L. Ryskina MD, MSHP, Emily Tu MS, Junning Liang MS, Seiyoun Kim PhD, Rachel M. Werner MD, PhD

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Abstract

Background

Efforts to increase transparency and accountability of nursing homes, and thus improve quality, now include information about changes in nursing home ownership. However, little is known about how change in ownership affects nursing home quality.

Methods

We conducted a retrospective cohort study of 15,471 U.S. nursing homes between January 2016 and December 2022, identifying all changes in ownership during that period. We used logistic regression to measure the association between nursing home characteristics and the odds of a change in ownership. A difference-in-differences model with multiple time periods was used to examine the impact of a change in ownership on the Medicare Nursing Home Compare 5-star ratings.

Results

One in five (23%) facilities changed ownership between 2016 and 2022. Nursing homes that were urban, for-profit, part of a chain, located in the South, had >50 beds, lower occupancy, higher percentage of stays covered by Medicaid, higher percentage of residents with non-white race, or a 1-star (poor) rating were more likely to undergo a change in ownership. There was a small statistically significant decrease in 5-star ratings after a change in ownership (−0.09 points on a 5-point scale; 95% CI −0.13 to −0.04; p < 0.001), driven primarily by a decrease in staffing ratings (−0.19 points; 95% CI −0.24 to −0.14; p < 0.001), and health inspections ratings (−0.07 points; 95% CI −0.11 to −0.03; p = 0.001). This was mitigated by an increase in quality measure ratings (0.15 points; 95% CI 0.10–0.20; p < 0.001).

Conclusion

Nursing Home Compare ratings decreased slightly after a change in facility ownership, driven by lower staffing and health inspection ratings and mitigated somewhat by higher quality measure ratings. These conflicting trends underscore the need for transparency around changes in facility ownership and a better understanding of consequences of changes in ownership that are salient to patients and families.

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疗养院所有权变更前后的星级比较。

背景：为了提高养老院的透明度和责任感，进而提高质量，现在养老院的所有权变更信息也被纳入其中。然而，人们对所有权变化如何影响养老院质量却知之甚少：我们对 2016 年 1 月至 2022 年 12 月期间的 15,471 家美国养老院进行了回顾性队列研究，确定了在此期间所有权的所有变化。我们使用逻辑回归法测算了养老院特征与所有权变更几率之间的关系。我们使用多时段差异模型来研究所有权变更对医疗保险疗养院比较五星评级的影响：每五家养老院中就有一家（23%）在 2016 年至 2022 年间变更了所有权。城市养老院、营利性养老院、连锁养老院、位于南方的养老院、床位数大于 50 张的养老院、入住率较低的养老院、享受医疗补助的住院比例较高的养老院、非白人居民比例较高的养老院，或评级为 1 星（差）的养老院更有可能发生所有权变更。所有权变更后，5 星评级在统计意义上有小幅下降（5 分制-0.09 分；95% CI -0.13 到 -0.04；P 结论）：疗养院所有权变更后，疗养院比较评分略有下降，原因是人员配备和健康检查评分降低，而质量衡量评分的提高在一定程度上缓解了这一趋势。这些相互矛盾的趋势凸显了机构所有权变更透明度的必要性，以及更好地了解所有权变更对患者和家属的影响的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.

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