Impact of public reporting on unreported quality of care.
OBJECTIVE
The impact of quality improvement incentives on nontargeted care is unknown and some have expressed concern that such incentives may be harmful to nontargeted areas of care. Our objective is to examine the effect of publicly reporting quality information on unreported quality of care.


METHODS
The nursing home Minimum Data Set from 1999 to 2005 on all postacute care admissions.


METHODS
We studied 13,683 skilled nursing facilities and examined how unreported aspects of clinical care changed in response to changes in reported care after public reporting was initiated by the Centers for Medicare and Medicaid Services on their website, Nursing Home Compare, in 2002.


RESULTS
We find that overall both unreported and reported care improved following the launch of public reporting. Improvements in unreported care were particularly large among facilities with high scores or that significantly improved on reported measures, whereas low-scoring facilities experienced no change or worsening of their unreported quality of care.


CONCLUSIONS
Public reporting in the setting of postacute care had mixed effects on areas without public reporting, improving in high-ranking facilities, but worsening in low-ranking facilities. While the benefits of public reporting may extend beyond areas that are being directly measured, these initiatives may also widen the gap between high- and low-quality facilities.
Werner
Rachel M
RM
Center for Health Equity Research and Promotion, Philadelphia VAMC, Division of General Internal Medicine, University of Pennsylvania School of Medicine, USA. rwerner@mail.med.upenn.edu
Konetzka
R Tamara
RT
Kruse
Gregory B
GB
D014487:Centers for Medicare and Medicaid Services, U.S.; D019992:Databases as Topic; D006801:Humans; D033181:Information Dissemination; D019221:Mandatory Reporting; D010343:Patient Admission; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012866:Skilled Nursing Facilities / Q000592:standards* / Q000706:statistics & numerical data; D014481:United States