Aiming for Star Performance: The Relationship Between Setting Targets and Improved Nursing Home Quality of Care

Objective: To evaluate relative improvement among nursing homes that set targets using the Nursing Home Setting Targets—Achieving Results (STAR) Site for 2 quality measures: (1) the proportion of long-stay residents who are physically restrained daily; and (2) the proportion of high-risk long-stay residents who have pressure ulcers. Setting and Participants: This analysis focuses on the 7091 Medicare- and/or Medicaid-certified nursing homes whose staff set STAR targets in 2005 for at least 1 of the 2 quality measures included in this analysis. Intervention: In 2005, the Centers for Medicare & Medicaid Services (CMS) launched STAR to help nursing homes select annual performance goals, or targets, for 4 outcomes that CMS publicly reports quarterly on Nursing Home Compare. Volunteer nursing homes used STAR to evaluate current clinical performance, identify targets, and then track their achievement of those targets. Measurements: To assess improvement, the project team calculated 4-quarter averages for baseline (ending the quarter when the target was set) and remeasurement (ending the quarter when the target expired) time periods. The team also estimated the number of lives impacted by improvements associated with setting STAR targets. Results: When compared to nursing homes that did not set physical restraint or pressure ulcer targets, nursing homes that set a target had significantly greater relative improvement for the associated quality measure. In particular, nursing homes that set physical restraint targets improved nearly twice as much on the physical restraint quality measure. These trends persisted regardless of nursing home characteristics (eg, facility size or membership in a multifacility corporation) or nursing homes'' intensive participation in work with their state''s Quality Improvement Organization (QIO). During the 1-year observation period, target setting was associated with 2576 fewer residents at risk for pressure ulcers developing a pressure ulcer and 4321 fewer residents being physically restrained. Conclusion: These analyses demonstrate consistently greater relative improvement among nursing homes that set STAR targets for the daily physical restraint or high-risk pressure ulcer quality measures than among nursing homes that did not set these targets. Although the absolute improvement is relatively small—less than 1% for each quality measure—the number of residents affected is substantial. If STAR targets were routinely incorporated into practice and this level of improvement realized by all nursing homes nationwide, an estimated 45,000 residents would experience better pressure ulcer and physical restraint outcomes at the end of 1 year. [Copyright &y& Elsevier]