Article Text

Download PDFPDF
Pay-for-performance policy and data-driven decision making within nursing homes: a qualitative study
  1. Kathleen Abrahamson1,
  2. Edward Miech2,
  3. Heather Wood Davila3,
  4. Christine Mueller3,
  5. Valerie Cooke4,
  6. Greg Arling1
  1. 1School of Nursing, Purdue University, West Lafayette, Indiana, USA
  2. 2Indiana University School of Medicine, Indianapolis, Indiana, USA
  3. 3School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
  4. 4Minnesota Department of Human Services, Minneapolis, Minnesota, USA
  1. Correspondence to Dr Kathleen Abrahamson, School of Nursing, Purdue University, 502 N. University Street, West Lafayette, Indiana 47907, USA; kaabraha{at}


Introduction Health systems globally and within the USA have introduced nursing home pay-for-performance (P4P) programmes in response to the need for improved nursing home quality. Central to the challenge of administering effective P4P is the availability of accurate, timely and clinically appropriate data for decision making. We aimed to explore ways in which data were collected, thought about and used as a result of participation in a P4P programme.

Methods Semistructured interviews were conducted with 232 nursing home employees from within 70 nursing homes that participated in P4P-sponsored quality improvement (QI) projects. Interview data were analysed to identify themes surrounding collecting, thinking about and using data for QI decision making.

Results The term ‘data’ appeared 247 times in the interviews, and over 92% of these instances (228/247) were spontaneous references by nursing home staff. Overall, 34% of respondents (79/232) referred directly to ‘data’ in their interviews. Nursing home leadership more frequently discussed data use than direct care staff. Emergent themes included using data to identify a QI problem, gathering data in new ways at the local level, and measuring outcomes in response to P4P participation. Alterations in data use as a result of policy change were theoretically consistent with the revised version of the Promoting Action on Research Implementation in Health Services framework, which posits that successful implementation is a function of evidence, context and facilitation.

Conclusions Providing a reimbursement context that facilitates the collection and use of reliable local evidence may be an important consideration to others contemplating the adaptation of P4P policies.

  • Nursing homes
  • Pay for performance
  • Quality improvement

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.