Relationship Between Nursing Home Compare Improvement in Function Quality Measure and Physical Recovery After Hip Replacement.

The study had no control group of nursing homes not required to report the quality measure. It was not a formal evaluation of the quality measure because it used the 14-day assessment rather than the discharge assessment and did not replicate the official exclusions. The analysis stopped at the 14-day assessment, while the median stay was 29 days and 25% of patients stayed 44 days or longer, so later recovery was not captured. Patients who died during the stay or lacked a 14-day assessment were excluded, which may have left a group more likely to improve. The before and after groups were not identical; the largest difference was incontinence, 63.3% before and 69.0% after. The percentage of patients with a fracture before hip replacement was lower after July 2016, which could affect expected recovery. The sample included only traditional fee-for-service Medicare, while about 30% of older adults are in Medicare Advantage. Other policies, including the 2016 Comprehensive Care for Joint Replacement Model, and nursing home market characteristics were not controlled.

The article metadata lists extramural NIH research support. The authors state no conflicts of interest.

Do not conclude that the nursing home quality measure caused better physical recovery. The study compared different patients before and after July 2016, had no control group, used only the 14-day assessment, and reported small changes, such as 1.00 to 1.06 points per 10 days.