title: Associations between published quality ratings of skilled nursing facilities and outcomes of medicare beneficiaries with heart failure.
abstract: BACKGROUND
  Nursing Home Compare quality ratings are designed to allow patients, families, and clinicians to compare facilities based on quality, but associations of the current measures with important clinical outcomes are not known. Our study examined associations between ratings and readmission and mortality among Medicare beneficiaries admitted to a skilled nursing facility with a primary diagnosis of heart failure.
  
  
  METHODS
  We conducted a retrospective cohort study of 164,672 Medicare beneficiaries discharged to skilled nursing facilities after hospitalization for heart failure in 2006-2007. The main outcome measures were readmission and mortality within 90 days.
  
  
  RESULTS
  One-fifth of the 13,619 skilled nursing facilities received a 1-star rating and 11% received a 5-star rating. Nearly half of the patients discharged to a skilled nursing facility were readmitted to a hospital within 90 days after discharge, and 30% died within 90 days. Compared with patients in 5-star skilled nursing facilities, patients in 1-star facilities had higher risks of 90-day readmission (hazard ratio, 1.08) and mortality (1.15). After adjustment for facility size and ownership type, the associations between the quality rating and readmission were not statistically significant, but the associations with mortality were significant.
  
  
  CONCLUSIONS
  Publicly reported Nursing Home Compare quality ratings of Medicare-certified skilled nursing facilities were modestly associated with 90-day readmission and mortality among Medicare beneficiaries discharged to these facilities after hospitalization for heart failure.
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA. kathleen.unroe@duke.edu
authors.forename: Kathleen T
authors.initials: KT
authors.lastname: Unroe
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Greiner
authors.forename: Cathleen
authors.initials: C
authors.lastname: Colón-Emeric
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D015577:Geriatric Assessment; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012107:Research Design; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities / Q000592:standards*; D016019:Survival Analysis; D014481:United States