The quality of quality measurement in U.S. nursing homes.
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.
Mor
Vincent
V
Department of Community Health, Brown University School of Medicine, Box G-A418, Providence, RI 02192, USA. Vincent_Mor@brown.edu
Berg
Katherine
K
Angelelli
Joseph
J
Gifford
David
D
Morris
John
J
Moore
Terry
T
D009735:Nursing Homes / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods*; D011787:Quality of Health Care; D012107:Research Design; D014481:United States