A new study from the Centers for Medicare & Medicaid Services has linked higher nursing home quality ratings with reduced COVID-19 outbreak severity and death. The findings support the use of the agency’s star ratings system for identifying areas needing improvement and reducing the risk of future infectious outbreaks, federal researchers say.

Using national and publicly reported CMS nursing home COVID-19 data, investigators tracked cumulative disease incidence and mortality through January 10, 2021. They also looked at the “persistent burden” of COVID-19 by measuring the number of weeks facilities spent in the top 10% nationally of weekly resident COVID-19 incidence.

By the study’s end date, 94% of nursing homes had reported at least one case of COVID-19 among their residents. More than 77% had at least one resident death, and 83% had been in the top 10% for at least one week, according to Lee A. Fleisher, M.D., the agency’s chief medical officer and director of its Center for Clinical Standards and Quality.

The data showed that higher nursing home quality ratings were “generally consistent” with lower disease transmission rates and fewer deaths, as well as with fewer high-incidence weeks — when adjusted for facility county-level characteristics, Fleisher and colleagues found.

“These findings indicate that the data and methodology used in the star ratings capture important aspects of quality related to infection control,” the authors said. “For example, nursing homes that ensure better compliance with federal regulations, or facilities that have higher staffing ratios, have a lower COVID incidence.”

The ratings may reflect other factors that were not measured in this study, the authors acknowledged, but the results suggest that nursing homes with relatively low star ratings or that residing in counties with higher infection rates may benefit from additional resources. This may include technical assistance on infection control practices that reduce the spread of COVID-19, such as effective hand hygiene, screening for symptoms of infection, and appropriate use of personal protective equipment. 

These measures — requirements for compliance with federal infection control standards — also are effective at preventing the transmission of other viruses, Fleisher and colleagues noted. Assuring compliance with these standards is central to the focused infection control surveys that are now included in health inspection ratings (as of January 2021), they concluded.

The study was published in the Journal of the American Geriatrics Society.