DESCRIPTION (provided by applicant): Quality report cards are intended to inform consumers, increase the demand elasticity for quality, enhance competition and as a result lead to quality improvement. Evidence to-date suggests that some report cards, such as the CMS Nursing Home Compare (NHC), may fall short on reaching these objectives because of the complexity of the information they provide. NHC includes information about staffing, deficiency citation and 18 Quality Measures (QMs). This large amount of information presents a challenge to consumers when choosing a nursing home. Individuals have been shown in prior studies to be able to make better choices when they have summary measures that integrate the multiple dimensions of quality and simplify their decision process. Recognizing this need, and in response to a request from Congress, CMS introduced the "5 Star" system in 2008. It offers summary measures along 4 dimensions: 1) an overall rating; 2) ratings based on QMs; 3) ratings based on staffing; 4) ratings based on deficiencies. The relative weights of each component in the summary measures reflect the preferences and recommendations made by an expert panel convened by CMS. This proposal is motivated by the recognition that an expert panel may not be representative of the "average" nursing home resident or family members, who are the actual decision makers. Therefore, the objective of this proposal is to elicit preferences of individuals with recent nursing home admission experience and use those preferences to develop and test alternative, consumer-driven, "5 Star" systems. To achieve this objective a survey will be administered to a large national sample of respondents with recent nursing home admission experience. The survey will elicit preferences with respect to nursing home quality, utilizing hedonic pricing and contingent valuation techniques. It will also gather information about socio-demographic, economic and health status to allow tests of hypotheses regarding the dependence of preferences on these factors. This information, in conjunction with quality measures calculated from the MDS and OSCAR files, will be used to develop two alternative composite ranking systems. The rankings based on hedonic pricing and contingent valuations would be compared to each other and to the "5 Star", expert panel based rankings. This project will offer information that could guide future improvements to the "5 Star" system, as called for by the Patient Protection and Affordable Care Act of 2010 (ACA). Furthermore, it is responsive to the priorities included in the "National Strategy for Quality Improvement in Health Care," which emphasizes patient and family preferences as guiding patient centered care.

PUBLIC HEALTH RELEVANCE: This project addresses a limitation of the Nursing Home Compare report card, a limitation which might minimize its effectiveness in informing consumers' search for quality providers, effective market competition, and optimal quality improvement. This project will develop an alternative to the current "5 STAR" system based on consumer preferences and health status, and will compare these alternatives to the current system, in order to inform designs of quality report cards.