Quality Improvement Efforts in VA Community Living Centers Following Public Reporting of Performance

ABSTRACT

For two decades, the U.S. government has publicly reported performance measures for most nursing homes, spurring some improvements in quality. Public reporting is new, however, to Department of Veterans Affairs nursing homes (Community Living Centers [CLCs]). As part of a large, public integrated healthcare system, CLCs operate with unique financial and market incentives. Thus, their responses to public reporting may differ from private sector nursing homes. In three CLCs with varied public ratings, we used an exploratory, qualitative case study approach involving semi-structured interviews to compare how CLC leaders (n = 12) perceived public reporting and its influence on quality improvement. Across CLCs, respondents said public reporting was helpful for transparency and to provide an “outside perspective” on CLC performance. Respondents described employing similar strategies to improve their public ratings: using data, engaging staff, and clearly defining staff roles vis-à-vis quality improvement, although more effort was required to implement change in lower performing CLCs. Our findings augment those from prior studies and offer new insights into the potential for public reporting to spur quality improvement in public nursing homes and those that are part of integrated healthcare systems.

KEYWORDS:

• Public reporting
• Quality of care
• Quality improvement
• Nursing Homes
• Veterans, consolidated framework for implementation research

Acknowledgments

The authors would like to dedicate this work to Lisa Minor, RN, BSN, MSSL (1967-2023), a great friend, colleague, and mentor. Ms. Minor served as National Director of Facility-Based Programs, U.S. Department of Veterans Affairs Office of Geriatrics and Extended Care, and provided valuable feedback on this paper. We are also grateful to the CLC leaders who participated in this study. An earlier version of this work, “Quality Improvement Activities in VA Community Living Centers Increased Following Public Reporting of Performance Information,” was presented at the AcademyHealth 2021 Annual Research Meeting.

Disclosure statement

No potential conflict of interest was reported by the authors.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported by Merit Review Award Number I21 H×002765 (to Dr. Pimentel), Research Career Scientist Award IK6 H×003398 (to Dr. Hartmann), and Career Development Award IK2 H×00318 (to Dr. Pimentel) Department Veterans Affairs Health Services Research and Development Service. Part of Dr. 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. The funder had no role in the preparation, review, or approval of the manuscript or decision to submit it for publication. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the U.S. Department of Veterans Affairs or the United States Government.