Star Ratings Support Postacute Decision Making Among Veterans

When determining postacute care options for veterans, findings showed comparisons of 1-star and 5-star Veterans Administration (VA) owned nursing homes called community living centers (CLCs) may provide helpful information.

“Identifying ways to alter the star ratings so they are differentially associated with outcomes meaningful to veterans at each level is essential,” wrote researchers.

A retrospective observational study was conducted utilizing national VA and Medicare data for veterans discharged to a CLC for postacute care who were aged 65 years and older, community-dwelling, experienced a hospitalization, and were discharged to a CLC in 2016-2017.

Researchers focused on postacute care outcomes including 30-day unplanned hospital readmission, 30-day mortality, 100-day successful community discharge, and unplanned readmission or death within 30-days of the hospital discharge.

Of 25,107 CLC admissions included in this study, 12,093 (48.2%) had a successful 100-day community discharge, 4088 (16.3%) experienced an unplanned readmission, and 4069 (16.2%) died within 30-days of hospital discharge.

When compared to 5-star facilities, admission to a lower-quality (1-star) facility was connected to lower odds of successful community discharge (OR 0.78; 95% CI 0.66, .91) and higher odds of a combined endpoint of 30-day mortality and readmission (OR 1.27; 95% CI 1.09, 1.49).

Researchers reported outcomes between 5-star and 2, 3, or 4-star facilities were not consistently different and when considered separately star ratings were not correlated with individual readmission or mortality outcomes.

“Yet, like past work on Centers for Medicare & Medicaid Services Nursing Home Compare ratings, these relationships were found to be inconsistent or not meaningful across all star levels,” concluded study authors. “CLC Compare may provide useful information for discharge and organizational planning, with some limitations.”

Reference:
Manges KA, Medvedeva E, Ersek M, Burke RE, et al. VA nursing home compare metrics as an indicator of skilled nursing facility quality for veterans. J Am Geriatr Soc. Published online June 9, 2022. doi:10.1111/jgs.17906