Measuring Nursing Home Performance Using Administrative Data

Bram Wouterse*, Pieter Bakx, Albert Wong

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)
39 Downloads (Pure)


To improve the quality of nursing home care, reliable estimates of outcomes are essential. Obtaining such estimates requires optimal use of limited data, especially for small homes. We analyze the variation in mortality and hospital admissions across nursing homes in the Netherlands during the years 2010–2013. We use administrative data on all nursing home clients. We apply mixed-effects survival models, empirical Bayes estimation, and machine-learning techniques to optimally use the available longitudinal data. We find large differences in both outcomes across nursing homes, yet the estimates are surrounded by substantial uncertainty. We find no correlation between performance on mortality and avoidable hospital admissions, suggesting that these are related to different aspects of quality. Hence, caution is needed when evaluating the performance of individual nursing homes, especially when the number of outcome indicators is limited.

Original languageEnglish
Pages (from-to)187-204
Number of pages18
JournalMedical Care Research and Review
Issue number2
Early online date23 Jul 2022
Publication statusPublished - Apr 2023

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research is funded by the Strategic Research Program of the National Institute for Public Health and the Environment (RIVM; project number S/210001).

Publisher Copyright:
© The Author(s) 2022.


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