title: What is nursing home quality and how is it measured?
abstract: 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.
authors.affiliation: Department of Health Policy & Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA. castlen@pitt.edu
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Castle
authors.forename: Jamie C
authors.initials: JC
authors.lastname: Ferguson
mesh_terms: D008134:Long-Term Care; D009735:Nursing Homes / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D014481:United States