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A nursing home's strategic orientation influences how it reacts to publication of its care quality scores

One-fourth of the nation's nursing homes have serious deficiencies in care that have caused actual harm or risk to residents. Publicizing nursing home quality is a market solution to the purely regulatory approach to improving the quality of nursing home care, notes William D. Spector, Ph.D., of the Agency for Healthcare Research and Quality. He and fellow researchers surveyed nursing home administrators at 1,502 nursing homes included in the first publication of the Nursing Home Compare Report conducted in May and June 2004. In addition to questions on whether and how they responded to publication, administrators were asked to select the strategic orientation (based on the typology developed by Miles and Snow) that best characterized their facility.

About 43 percent of the 724 responding administrators self-typed as defenders (compete on efficiency and services), followed by analyzers (33 percent, strive to maintain a stable base of products and services), prospectors (19 percent, compete on innovation), and reactors (6.6 percent, lack a consistent strategy). While 37 percent of those surveyed took action immediately after the initial publication of the quality measures, nearly 30 percent took no action at all.

Whether and how facilities responded was associated with strategic orientation. Compared with defenders, prospectors were 58 percent more likely and reactors were 74 percent less likely to respond immediately after the first quality measure reporting period. Analyzers were likely to immediately respond to the quality reports, but not as strongly as prospectors. Relative to defenders, both prospectors and analyzers were more likely to investigate the reasons for poor scores. Compared with defenders at facilities with poor scores, prospectors were almost twice as likely and analyzers 67 percent more likely to change priorities of existing quality programs.

More details are in "Strategic orientation and nursing home response to public reporting of quality measures: An application of the Miles and Snow typology," by Jacqueline S. Zinn, Ph.D., Dr. Spector, David L. Weimer, Ph.D., and Dana B. Mukamel, Ph.D., in the April 2008 HSR: Health Services Research 43(2), pp. 598-615.

Reprints (AHRQ Publication No. 08-R070) are available from the AHRQ Publications Clearinghouse.

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