title: The quality of quality measurement in U.S. nursing homes.
abstract: OBJECTIVE
  This article examines various technical challenges inherent in the design, implementation, and dissemination of health care quality performance measures.
  
  
  METHODS
  Using national and state-specific Minimum Data Set data from 1999, we examined sample size, measure stability, creation of ordinal ranks, and risk adjustment as applied to aggregated facility quality indicators.
  
  
  RESULTS
  Nursing home Quality Indicators now in use are multidimensional and quarterly estimates of incidence-based measures can be relatively unstable, suggesting the need for some averaging of measures over time.
  
  
  CONCLUSIONS
  Current public reports benchmarking nursing homes' performances may require additional technical modifications to avoid compromising the fairness of comparisons.
authors.affiliation: Department of Community Health, Brown University School of Medicine, Box G-A418, Providence, RI 02192, USA. Vincent_Mor@brown.edu
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
authors.forename: Katherine
authors.initials: K
authors.lastname: Berg
authors.forename: Joseph
authors.initials: J
authors.lastname: Angelelli
authors.forename: David
authors.initials: D
authors.lastname: Gifford
authors.forename: John
authors.initials: J
authors.lastname: Morris
authors.forename: Terry
authors.initials: T
authors.lastname: Moore
mesh_terms: D009735:Nursing Homes / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods*; D011787:Quality of Health Care; D012107:Research Design; D014481:United States