A national, Web-based report card on nursing homes is improving some aspects of nursing home care, a new study finds.

The Centers for Medicare & Medicaid Services began publishing the "Nursing Home Compare" report card results on the Web in 2002. The site gives detailed information about the past performance of every Medicare- and Medicaid-certified nursing home in the country.

According to lead investigator Dana Mukamel, Ph.D., the study is the first "to investigate the impact of a report card on quality of nursing home care." Previous such studies have focused on health plans, hospitals or physicians.

The study will appear online and in the upcoming issue of Health Services Research.

Mukamel, a researcher at the Center for Health Policy Research and the Department of Medicine at the University of California at Irvine, said that the report cards can have a policy-level impact: "If patients, physicians, social workers and state regulators use these report cards, nursing homes will see strong economic incentives to invest in quality care."

Mukamel and colleagues sent out surveys to a random sampling of Medicare- and Medicaid-certified nursing homes that had had at least one quality measure published on the first "Nursing Home Compare" report in 2002. About 700 facilities responded to the survey.

The researchers looked at changes in five of the most important quality measures of nursing home care.

For long-term nursing home residents, quality measures included the percentages of residents (1) with worsening ability to perform daily living skills, (2) with new infections, (3) with pressure ulcers and (4) who were physically restrained. For short-term residents, the quality measure was percentage of residents with moderate daily pain or any episodes of excruciating pain.

Researchers found that the quality measures of physical restraint and short-term pain improved after the publication of the report card. Both showed about a 10 percent improvement from the study's starting point.

However, the other measures did not show improvement. "This may reflect the longer lead time required before improvement can be observed in these other areas of care," Mukamel said

Marilyn Rantz, Ph.D., R.N., a researcher in nursing home quality at the University of Missouri, concurred: "The lack of improvement in infections, pressure ulcers and the ability to perform living skills doesn't mean the report cards aren't useful. These quality measures are more clinically complex and require greater intervention for improvement." Rantz was not associated with the study.

"Report cards are not perfect, but we've got to have some sort of measurement not only for the nursing home industry to use, but for consumers to compare nursing homes," Rantz said. "This study provides evidence that quality report cards are useful tools."

According to Mukamel, the report cards provide patients and families with information that was unavailable just four or five years ago. "When they are at the point where they need to choose a nursing home they can go to the Web and compare nursing homes available in their neighborhoods. They can see which ones have better outcomes."

Health Services Research is the official journal of the AcademyHealth and is published by Blackwell Publishing on behalf of the Health Research and Educational Trust.

Mukamel DB, et al. Publication of quality report cards and trends in reported quality measures in nursing homes. Health Services Research online, 2008.

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