Inside the Black Box of Improving on Nursing Home Quality Measures

Heather Davila, Tetyana P. Shippee, Young Shin Park, Daniel Brauner, Rachel M. Werner, R. Tamara Konetzka

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Nursing Home Compare (NHC) reports quality measures (QMs) for nursing homes (NHs) as part of its 5-star rating system. Most of the QMs are based on facility self-reported data, prompting questions about their validity. To better understand how NHs interact with the QMs, we used qualitative methods, including semistructured interviews with NH personnel (n = 110), NH provider association representatives (n = 23), and observations of organizational processes in 12 NHs in three states. We found that most NHs are working to improve the quality of care they provide, not merely their QM scores. However, our interviews and observations revealed limitations with the QMs, suggesting that the QMs—on their own—may not accurately reflect the quality of care NHs provide. Our findings suggest several changes to improve NHC, including adding information related to resident and family experience, providing greater risk adjustment, and providing incentives for NHs that serve socially and medically complex residents.

Original languageEnglish (US)
Pages (from-to)758-770
Number of pages13
JournalMedical Care Research and Review
Issue number6
Early online dateSep 28 2020
StatePublished - Dec 2021

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by a grant from the Agency for Healthcare Research and Quality to R. Tamara Konetzka, University of Chicago (R01HS024967).

Funding Information:
Heather Davila’s time to write this manuscript was supported by the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Health Services Research, the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System.


  • long-term care
  • nursing homes
  • public reporting
  • qualitative
  • quality improvement


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