Problem: The nursing home sector is under constant pressure to improve quality and reduce costs. In particular Medicare and Medicaid administrators want to ensure that quality care is provided at affordable costs. Comparing the performance of nursing homes across geographic regions is difficult for a host of reasons. Labor rates can vary dramatically from one locale to another. Some nursing homes are affiliated with a hospital while others are not. Some facilities are for-profit while others are nonprofit. Also the severity of the conditions of the residents can vary dramatically across settings. Some residents require minimal staff intervention on a daily basis