Overall Care and Hospital Admission Rates Improving in Nursing Homes

There are currently fewer hospital admissions and readmissions among nursing home residents, according to The Commonwealth Fund’s Scorecard on Local Health System Performance, and the overall quality of care in nursing homes has improved. The Scorecard compares access to healthcare, quality, avoidable hospital use, costs of care and health outcomes.

The 2016 edition of the Scorecard assesses the state of healthcare in more than 300 communities across the United States from 2011 to 2014, a time of great change in the industry as officials across the country implemented the Affordable Care Act.

Researchers from The Commonwealth Fund use the most recent data available from publicly available data sources, including government-sponsored surveys, registries, vital statistics, publicly reported quality-of-care indicators, mortality data, and administrative databases to create the Scorecard.

The Scorecard ranks 306 hospital referral regions on four main dimensions of performance:

• Access and affordability
• Prevention and treatment
• Affordable hospital use and cost
• Healthy lives

These four dimensions include 36 indicators of access, quality, avoidable hospital use, costs, and outcomes. They examined changes in local performance on the 33 indicators the researchers could track over time. The Scorecard reports on how many of the 306 regional areas improved, remained the same, or worsened in their performance of those indicators.

The 2016 Scorecard found important information about nursing homes. The researchers found that, for example, there were fewer 30-day readmissions among nursing home residents and reduced hospital admissions among long-stay residents.

Results from the 2016 Scorecard

The results of the 2016 Scorecard show that many communities in the nation saw improvements in several areas, including fewer uninsured residents, more efficient use of hospitals, and better quality of care in hospitals and doctor offices. The Scorecard also reports fewer deaths from treatable cancers in these communities. Widespread differences between areas do persist, however, and these disparities serve as a reminder that many local health systems lag behind.

More local communities improved than worsened on 28 of the 33 indicators researchers could track over time. Most local areas made meaningful gains in many of these areas, including improvements in quality of care indicators relevant to nursing home residents.

Quality of care for nursing home residents improved in several areas, including:

• Nursing home residents receiving an antipsychotic medication (197 improved, 109 remained the same, none worsened)
• Elderly patients receiving a contraindicated prescription drug (177 improved, 122 remained the same, 7 worsened)
• Elderly patients receiving a high-risk prescription drug (175 improved, 127 remained the same, 4 worsened)

In regards to short-stay nursing home residents with a 30-day readmission to the hospital, 126 areas improved, 163 remained the same, and 17 worsened. Of the 306 areas included in the Scorecard, 71 improved when it came to long-stay nursing home residents with a hospital admission, 225 remained the same and 10 worsened. When it came to people with poor health-related quality of life, 87 improved, 181 stayed the same and 10 worsened.

Of the 306 communities, 127 areas improved in their care for high-risk nursing home residents with pressure sores while the care in 65 communities worsened and 114 remained the same. Some indicators showed mixed results.

The Scorecard attributes the overall improvement of nursing home quality to recent policy changes adopted by the post-acute sector. The authors of the Scorecard say that Nursing Home Compare and other national quality reporting programs “shine a spotlight on treatment provided in hospital, post-acute, and long-term care settings—all of which have seen clear gains in recent years.”

Study Information

The researchers used MDS minimum data sets via the Centers for Medicare & Medicaid Services CMS Nursing Home Compare for past statistics from January to September 2013 and current January to September 2015 statistics relating to high-risk nursing home residents with pressure sores and long-stay nursing home residents with an antipsychotic medication. The team used 2010 and 2012 information from MedPAR and MDS to measure an area’s performance in short-stay nursing home residents readmitted to a hospital within 30 days of discharge and long-stay nursing home residents hospitalized within a six-month period. They ascertained the number of potentially avoidable emergency department visits among Medicare beneficiaries through 2011 and 2013 data provided by Medicare SAF standard analytical files.

Geographic Differences in Care

Performance improved more than it declined in nearly all U.S. communities. This finding suggests that, with supportive policies and local action, progress in all communities is possible. Scorecard results, however, do suggest that where a person lives matters – while there is widespread progress and pockets of high performance, some local healthcare delivery systems provide more benefit to the people of their communities than do others.

Regions in Hawaii, the San Francisco Bay area, the Upper Midwest and New England continue to be performance leaders. Many regions showed improvements in the rate of high-risk nursing home residents with pressure ulcers and in those receiving contraindicated high-risk prescription drugs. Policymakers, health system leaders and community stakeholders use the gains in these areas as achievable improvement benchmarks.

People living inside top-performing areas of the country may have strikingly different healthcare experiences than do those living in bottom-performing areas. The report shows significant geographic variations in several indicators, including the number of older residents who received a high-risk prescription drug, contraindicated prescription drug, short-stay nursing home residents with a 30-day readmission rate to the hospital, and long-stay nursing home residents with a 30-day hospital readmission.

The Scorecard does indicate the existence of improvements in some areas and the need for improvement in others. The authors say that the differences between the states and various hospital referral regions are a “reminder that many local health systems have yet to reach the potential attained elsewhere in the country.”

Variations in quality exist even within geographic areas. The Scorecard provides interactive map that breaks down overall improvement by location. Users can type in their zip codes or hospital referral region (HRR) code to learn how their local healthcare institution measures up.

The authors of Scorecard are quick to point out that, despite these differences in quality, healthcare across the nation has recently “improved more than it worsened.”