title: Have Nursing Home Compare quality measure scores changed over time in response to competition?
abstract: BACKGROUND
  Currently, the Centers for Medicare and Medicaid Services report on 15 Quality Measures (QMs) on the Nursing Home Compare (NHC) website. It is assumed that nursing homes are able to make improvements on these QMs, and in doing so they will attract more residents. In this investigation, we examine changes in QM scores, and whether competition and/or excess demand have influenced these change scores over a period of 1 year.
  
  
  METHODS
  Data come from NHC and the On-line Survey Certification And Recording (OSCAR) system. QM change scores are calculated using values from January 2003 to January 2004. A series of regression analyses are used to examine the association of competition and excess demand on QM scores.
  
  
  RESULTS
  Eight QMs show an average decrease in scores (ie, better quality) and six QMs show an average increase in scores (ie, worse quality). However, for 13 of the 14 QMs these average changes averaged less than 1%. The regression analyses show an association between higher competition and improving QM scores and an association between lower occupancy and improving QM scores.
  
  
  CONCLUSIONS
  As would be predicted based on the market-driven mechanism underlying quality improvements using report cards, we show that it is in the most competitive markets and those with the lowest average occupancy rates that improvements in the QM scores are more likely.
authors.affiliation: Graduate School of Public Health, Pittsburgh, Pennsylvania, USA. castlen@pitt.edu
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Castle
authors.forename: John
authors.initials: J
authors.lastname: Engberg
authors.forename: Darren
authors.initials: D
authors.lastname: Liu
mesh_terms: D000203:Activities of Daily Living; D001509:Bed Occupancy / Q000639:trends; D014487:Centers for Medicare and Medicaid Services, U.S.; D002568:Certification; D003258:Consumer Behavior / Q000706:statistics & numerical data; D016208:Databases, Factual; D004465:Economic Competition / Q000639:trends*; D019538:Health Care Surveys; D006301:Health Services Needs and Demand / Q000639:trends*; D006801:Humans; D008484:Medicaid / Q000592:standards; D006278:Medicare / Q000592:standards; D009735:Nursing Homes / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000639:trends*; D019984:Quality Indicators, Health Care / Q000639:trends*; D014481:United States