title: Rationale and study protocol for the Nursing Home Compare Plus (NHCPlus) randomized controlled trial: A personalized decision aid for patients transitioning from the hospital to a skilled-nursing facility.
abstract: BACKGROUND
  Annually more than 3 million people are admitted to one of the 15,965 skilled nursing facilities (SNFs) in the United States, with 90% of admissions occurring from a hospital. Although the Centers for Medicare and Medicaid Services (CMS) publishes several internet-based report cards, including one for nursing homes (Nursing Home Compare, NHC), they are not widely used. This is due, in part, to the complexity of the information available and the fact that the choice of nursing homes is typically made while in the hospital without access to the web-based NHC. We developed Nursing Home Compare Plus (NHCPlus) to address these limitations and to improve the decision-making process.
  
  
  METHODS
  This paper describes the design and rationale of a two-arm randomized controlled trial designed to test the effectiveness of NHCPlus compared to usual care only, in a sample of patients being discharged from the hospital to an SNF (N=229). Assessments were conducted within 24h prior to patient discharge and 30-days post discharge. Primary outcomes to be examined included the use of NHC, increased choice of nursing homes with better reported outcomes, and increased distance between patient/family residence and nursing home. Secondary outcomes included satisfaction with the decision to go to a nursing home, confidence in the choice of nursing home, and reduced hospital length of stay.
  
  
  CONCLUSIONS
  NHCPlus is an innovative mobile application designed to allow patients to personalize their choice of nursing homes to meet their medical needs and preferences. The application to other quality report cards is discussed.
authors.affiliation: Department of Medicine, Division of General Internal Medicine; University of California, Irvine, 100 Theory, Suite 100, Irvine, CA 92697-5800, United States. Electronic address: dsorkin@uci.edu.
authors.forename: Dara H
authors.initials: DH
authors.lastname: Sorkin
authors.affiliation: Department of Medicine, University of California, Irvine, Department of Medicine Admin, City Tower, Suite 400, Orange, CA 92688-4076, United States. Electronic address: anamin@uci.edu.
authors.forename: Alpesh
authors.initials: A
authors.lastname: Amin
authors.affiliation: Lafollette School of Public Affairs, University of Wisconsin-Madison, 1225 Observatory Dr. Madison, WI 53706, United States. Electronic address: weimer@lafollette.wisc.edu.
authors.forename: David L
authors.initials: DL
authors.lastname: Weimer
authors.affiliation: Department of Industrial Engineering, University of Miami, 1251 Memorial Drive, Coral Gables, FL 33124, United States. Electronic address: jsharit@miami.edu.
authors.forename: Joseph
authors.initials: J
authors.lastname: Sharit
authors.affiliation: Department of Medicine, Division of General Internal Medicine; University of California, Irvine, 100 Theory, Suite 100, Irvine, CA 92697-5800, United States. Electronic address: hladd@uci.edu.
authors.forename: Heather
authors.initials: H
authors.lastname: Ladd
authors.affiliation: Department of Medicine, Division of General Internal Medicine; University of California, Irvine, 100 Theory, Suite 100, Irvine, CA 92697-5800, United States. Electronic address: dmukamel@uci.edu.
authors.forename: Dana B
authors.initials: DB
authors.lastname: Mukamel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002140:California; D002755:Choice Behavior; D003661:Decision Support Techniques; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D063731:Mobile Applications; D009735:Nursing Homes; D010351:Patient Discharge; D012866:Skilled Nursing Facilities; D014481:United States