Do High Rates of OSCAR Deficiencies Prompt Improved Nursing Facility Processes and Outcomes?

• Published in: Journal of aging & social policy 2011-10, Vol.23 (4), p.384-407
• Main Authors: Klopfenstein, Kristin, Lockhart, Charles, Giles-Sims, Jean
• Format: Article
• Language: English
• Subjects: assessing nursing facility quality; Benefits; Centers for Medicare and Medicaid Services (U.S.) - economics; Certification - methods; changes in nursing facility quality; Cost; Cultural Change; Culture; Health Care Surveys; Health Services for the Aged - economics; Health Services for the Aged - manpower; Health Services for the Aged - standards; Health technology assessment; Humans; Indexes; Internet; Long Term Care; Long-Term Care - organization & administration; Management Audit; Medicaid; Medicaid program; Medicare; Medicare - economics; Methodology (Data Collection); Nurses; Nursing; nursing facility quality; Nursing Staff - supply & distribution; Outcome and Process Assessment (Health Care) - statistics & numerical data; Personnel Staffing and Scheduling Information Systems - statistics & numerical data; Polls & surveys; Quality Indicators, Health Care - statistics & numerical data; Quality of care; Quality of Health Care; reliability and validity of nursing facility quality measures; Research Report; Residential Facilities - economics; Residential Facilities - manpower; Residential Facilities - standards; Social Programs; state Medicaid nursing facility long-term care programs; Surveys; United States
• ISSN: 0895-9420; 1545-0821
• DOI: 10.1080/08959420.2011.605667

Recently, some researchers have argued that high state rates of Centers for Medicare and Medicaid Services (CMS) Online Survey, Certification and Reporting (OSCAR) nursing facility deficiencies indicate stringent enforcement, leaving the impression of better-quality care soon to follow; others maintain that the rank ordering of states' quality of nursing facility care remains fairly constant, resting on deep-seated state characteristics that change slowly, so that short-term improvement in poor-quality care is unlikely. The authors examine change in the process and outcome quality of states' Medicare nursing facility long-term care programs across 1999 to 2005, using linear and two-stage least squares regression. They find that (1) nationally, process quality generally falls across this period while outcome quality generally increases; (2) neither a prominent enforcement stringency index nor state culture, a relatively stable state characteristic, exerts much influence on state process and outcome quality scores over time, but (3) the relative costs and benefits for CMS compliance appear to contribute to explaining change in states' quality of resident outcomes over time; and (4) states' process quality is much less stable than outcome quality, and outcome indices distinct from OSCAR deficiency data provide more reliable and possibly more valid measures of care quality.