![]() In early 2018, CLC Strategic Analytics for Improvement and Learning was augmented with additional data and became CLC Compare. National internal-to-VA reporting of quality measures began in fiscal year (FY) 2016 with CLC Strategic Analytics for Improvement and Learning. In the United States Department of Veterans Affairs (VA), nursing homes-known as Community Living Centers (CLCs)-exhibit variable levels of measured quality. A second survey administered in 2007 found that more administrators (57%) believed that quality measures reflect the true quality of care, but up to 80% admitted to making no major investments in response to report cards. A small but critical number of nursing homes used potentially dysfunctional strategies, that is, reallocating staff from other activities to care related to a poor-performing quality measure (a teaching-to-the-test response 9%) and changing the types of patients admitted ( cream-skimming 4%). Overall, 63% further investigated their scores, 42% changed the priorities of existing QI efforts, and 20% started new QI programs. Nursing homes with poor scores were also more likely to act than nursing homes with better scores. Many administrators (40%) were ambivalent about the validity of quality measures. An initial survey in 2004 (724/1502, 48.2% response rate) found that although 80% of nursing home administrators had viewed their first report card, subsequent action depended on their perception of the validity of the scores. In a separate study, Mukamel et al used the Nursing Home Compare survey to understand nursing home administrators’ responses to Nursing Home Compare. Nursing home–level use of antipsychotic medications and physical restraints, ambulation, and pain prevalence improved, largely driven by actions that nursing home providers took to enhance care quality. ![]() ![]() Previous studies found that quality on some postacute quality measures improved after the launch of Nursing Home Compare, especially in nursing homes that began QI activities in response to their report cards or that were subject to public reporting requirements. These report cards theoretically incentivize nursing home providers to compete on quality by, for example, investing in quality improvement (QI) to maintain or increase market share. This mechanism has been used in the nursing home sector since 2002, when the United States Centers for Medicare and Medicaid Services (CMS) launched the Nursing Home Compare website, which enables consumers to make choices based on quality. Public reporting seeks to improve quality by addressing informational asymmetries in health care.
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