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Incorporating patient and family preferences and medical needs into Medicare’s five-star rating system for nursing homes results in substantially different rankings, according to a  reported today in Health Affairs. The authors developed an application that allows patients and families to personalize the Centers for Medicare & Medicaid Service’s five-star rating system for nursing homes based on their preferences and medical needs, and tested it with 146 patients discharged from the hospital to nursing homes. When comparing the application with Medicare’s five-star ratings, they found “only minimal agreement on ranking of nursing homes.” The April issue of the journal focuses on consumer use of evidence to inform health care decisions.