title: Evaluating nursing home performance indicators: an illustration exploring the impact of facilities on ADL change.
abstract: OBJECTIVE
  Performance measurement systems for nursing homes assume that facility performance contributes heavily to individual outcomes. This research illustrates how that assumption can be assessed using the change in residents' activities of daily living (ADLs).
  
  
  METHODS
  The data used in these analyses were all from residents with both an admission and a quarterly assessment in a sample of all admissions to a randomly chosen 10% of Medicare- or Medicaid-certified nursing homes operating during 2002.
  
  
  RESULTS
  Models including both facility and individual variables explained up to 20% of the variation in ADL change after admission. Facility identity in isolation explained between 8% and 14% of the variation in ADL change.
  
  
  CONCLUSIONS
  The results suggest that quality indicators based on change in ADLs may be problematic when used in nursing home performance measurement systems. More generally, the results recommend that the level of variation in performance measures attributable to facility identity or performance become a much more central consideration when researchers evaluate quality indicators for use in nursing home performance measurement systems.
authors.affiliation: School of Rural Public Health, 1266 TAMU, College Station, TX 77843, USA. phillipscd@srph.tamhsc.edu
authors.forename: Charles D
authors.initials: CD
authors.lastname: Phillips
authors.forename: Rongjun
authors.initials: R
authors.lastname: Shen
authors.forename: Min
authors.initials: M
authors.lastname: Chen
authors.forename: Michael
authors.initials: M
authors.lastname: Sherman
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000592:standards*; D017063:Outcome Assessment, Health Care; D019984:Quality Indicators, Health Care