CLC Compare may provide useful information for discharge and organizational planning, with some limitations. Yet, like past work on CMS Nursing Home Compare ratings, these relationships were found to be inconsistent or not meaningful across all star levels. We found that 1-star facilities had higher rates of 30-day unplanned hospital readmission/death, and lower rates of 100-day successful community discharges compared to 5-star facilities. Identifying ways to alter the star ratings so they are differentially associated with outcomes meaningful to Veterans at each level is essential.
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These findings suggest comparisons of 1-star and 5-star CLCs may provide meaningful information for Veterans making decisions about post-acute care. Star ratings were not associated with individual readmission or mortality outcomes when considered separately. However, outcomes were not consistently different between 5-star and 2, 3, or 4-star facilities. Admission to a lower-quality (1-star) facility was associated with lower odds of successful community discharge (OR 0.78 95% CI 0.66, 0.91) and higher odds of a combined endpoint of 30-day mortality and readmission (OR 1.27 95% CI 1.09, 1.49), compared to 5-star facilities. Of the 25,107 CLC admissions, 4088 (16.3%) experienced an unplanned readmission, 4069 (16.2%) died within 30-days of hospital discharge, and 12,093 (48.2%) had a successful 100-day community discharge. PAC outcomes included 30-day unplanned hospital readmission, 30-day mortality, 100-day successful community discharge, and a secondary composite outcome of unplanned readmission or death within 30-days of the hospital discharge. Our sample included Veteran enrollees age 65+ who were community-dwelling, experienced a hospitalization, and were discharged to a CLC in 2016–2017.
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We used a multivariate regression model with hospital random effects to examine the association between CLC Compare overall star ratings and PAC outcomes while controlling for patient, facility, and hospital factors.
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Retrospective observational study using national VA and Medicare data for Veterans discharged to a CLC for PAC. However, the relationship between CLC Compare star ratings and Veterans CLC post-acute outcomes is unknown. In 2016, the VA released CLC Compare star ratings to support decision-making. The updated Star Ratings increase transparency in support. The Veterans Administration (VA) provides several post-acute care (PAC) options for Veterans, including VA-owned nursing homes (called Community Living Centers, CLCs). The Centers for Medicare & Medicaid Services today (July 27, 2022) launched its enhanced Nursing Home Five-Star Quality Rating System which integrates data nursing homes report on their weekend staffing rates for nurses and information on annual turnover among nurses and administrators.