title: Nursing home quality: a comparative analysis using CMS Nursing Home Compare data to examine differences between rural and nonrural facilities.
abstract: BACKGROUND
  Advances in medicine and an aging US population suggest that there will be an increasing demand for nursing home services. Although nursing homes are highly regulated and scrutinized, their quality remains a concern and may be a greater issue to those living in rural communities. Despite this, few studies have investigated differences in the quality of nursing home care across the rural-urban continuum. The purpose of this study was to compare the quality of rural and nonrural nursing homes by using aggregated rankings on multiple quality measures calculated by the Centers for Medicare and Medicaid Services and reported on their Nursing Home Compare Web site.
  
  
  METHODS
  Independent-sample t tests were performed to compare the mean ratings on the reported quality measures of rural and nonrural nursing homes. A linear mixed binary logistic regression model controlling for state was performed to determine if the covariates of ownership, number of beds, and geographic locale were associated with a higher overall quality rating.
  
  
  RESULTS
  Of the 15,177 nursing homes included in the study sample, 69.2% were located in nonrural areas and 30.8% in rural areas. The t test analysis comparing the overall, health inspection, staffing, and quality measure ratings of rural and nonrural nursing homes yielded statistically significant results for 3 measures, 2 of which (overall ratings and health inspections) favored rural nursing homes. Although a higher percentage of nursing homes (44.8%-42.2%) received a 4-star or higher rating, regression analysis using an overall rating of 4 stars or higher as the dependent variable revealed that when controlling for state and adjusting for size and ownership, rural nursing homes were less likely to have a 4-star or higher rating when compared with nonrural nursing homes (OR = .901, 95% CI 0.824-0.986).
  
  
  CONCLUSIONS
  Mixed model logistic regression analysis suggested that rural nursing home quality was not comparable to that of nonrural nursing homes. When controlling for state and adjusting for nursing home size and ownership, rural nursing homes were not as likely to earn a 4-or higher star quality rating as nonrural nursing homes.
authors.affiliation: Essentia Institute of Rural Health, Research Division, Duluth, MN 55805, USA. mlutfiyya@eirh.org
authors.forename: May Nawal
authors.initials: MN
authors.lastname: Lutfiyya
authors.forename: Charles E
authors.initials: CE
authors.lastname: Gessert
authors.forename: Martin S
authors.initials: MS
authors.lastname: Lipsky
mesh_terms: D006801:Humans; D016015:Logistic Models; D008134:Long-Term Care; D015999:Multivariate Analysis; D009735:Nursing Homes; D011787:Quality of Health Care; D019035:Rural Health Services; D014481:United States
keywords: Rural nursing home quality; rural long term care