Nursing Home Star Ratings and New Onset of Depression in Long-Stay Nursing Home Residents.
Yiyang Yuan, Kate L Lapane, Jonggyu Baek and 2 others
PMID 31281113WHAT IT FOUND
Overall star ratings were not linked to new depression diagnosis at 90 days.
Higher overall or quality-measure ratings were linked to fewer depressive symptoms; 1-star staffing was linked to more severe symptoms.
Key findings
01At 90 days after admission, 14.1% of residents had a new depression diagnosis, 8.5% had mild symptoms, and 2.6% had moderate to severe symptoms.
02Overall star ratings were not associated with new depression diagnosis at 90 days.
03Compared with 3-star homes, residents in 5-star overall homes were 12% and 31% less likely to have mild and moderate symptoms; residents in 1-star staffing homes were 37% and 57% more likely to have moderate and moderately severe/severe symptoms than residents in average staffing homes; residents in 5-star quality-measure homes were 15%, 24%, and 25% less likely to have mild, moderate, and moderately severe/severe symptoms than residents in 3-star homes.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was an observational study of existing records, so it cannot show that star ratings caused depression diagnosis or symptoms. The study did not test a nursing home intervention, so it cannot show what change in staffing, inspection, or quality measures would improve depression outcomes. Residents in 1-star homes differed from residents in better-rated homes on age, sex, race/ethnicity, and facility characteristics, even after adjustment. Depression diagnosis may have been influenced by how well homes recognised and documented depression, so the lack of association with diagnosis may reflect measurement differences. The study did not know whether antidepressants were prescribed for depression or whether they were appropriate or effective. Important confounders such as loss of a home or family member and changes over time were not measured. The outcomes were assessed only at the first 90 day period, so the study does not describe depression risk after that. With a very large sample, small differences could be statistically significant, but authors used a 5% absolute difference threshold for noteworthy differences.
Declared interests
All authors declared no financial or personal conflicts of interest relevant to the article. The publication types list NIH extramural research support.
The easy way to misread this
Do not conclude that higher star ratings prevent depression or that improving a rating will reduce depression. The study found no association between overall star ratings and new depression diagnosis, and the symptom associations are observational, so they cannot prove cause.