What is nursing home quality and how is it measured?
OBJECTIVE
In this commentary, we examine nursing home quality and indicators that have been used to measure nursing home quality.


METHODS
A brief review of the history of nursing home quality is presented that provides some context and insight into currently used quality indicators. Donabedian's structure, process, and outcome (SPO) model is used to frame the discussion. Current quality indicators and quality initiatives are discussed, including those included in the Facility Quality Indicator Profile Report, Nursing Home Compare, deficiency citations included as part of Medicare/Medicaid certification, and the Advancing Excellence Campaign.


RESULTS
Current quality indicators are presented as a mix of structural, process, and outcome measures, each of which has noted advantages and disadvantages. We speculate on steps that need to be taken in the future to address and potentially improve the quality of care provided by nursing homes, including report cards, pay for performance, market-based incentives, and policy developments in the certification process. Areas for future research are identified throughout the review.


CONCLUSIONS
We conclude that improvements in nursing home quality have likely occurred, but improvements are still needed.
Castle
Nicholas G
NG
Department of Health Policy & Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA. castlen@pitt.edu
Ferguson
Jamie C
JC
D008134:Long-Term Care; D009735:Nursing Homes / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D014481:United States