60 Seconds with... David Stevenson

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Q: What did your study of almost 1 million consumer complaints about nursing homes (1998-2002) reveal? A: They're useful as a supplemental measure of quality and for that reason, they'd be best viewed in combination with other quality measures, such as MDS measures. It seems they're best equipped to identify poor performing nursing homes. There's less ability to distinguish between the good and adequate nursing homes.

Q: What else did the complaints uncover?

A: In some ways, they fulfilled expectations, in terms of associations. They positively correlated with deficiencies and negatively correlated with nurse staffing. If you had more nurses and nurse aides, you tended to have fewer complaints. But these are all associations; it doesn't necessarily mean if you had more nurses, you'd get fewer complaints.

Q: What really caught your eye?

A: It wasn't unexpected, but it's striking to see how much complaint rates can vary across state lines. Another thing was that the complaint rate is fairly low. Fifty percent of facilities had zero or one complaint. It doesn't necessarily mean quality is great. I would probably argue there are substantial barriers to residents complaining and registering.

Q: What were the most common types of complaints investigated?

A: A lot of them were resident-care focused (40%), then abuse and neglect (24%) and then resident rights (11%).

David Stevenson, Ph.D. is assistant professor of Health Policy,
Harvard Medical School