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Sharma H, Perraillon MC, Werner RM, Grabowski DC, Konetzka RT. Medicaid and Nursing Home Choice: Why Do Duals End Up in Low-Quality Facilities? J Appl Gerontol 2019; 39:981-990. [PMID: 30957619 DOI: 10.1177/0733464819838447] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We provide empirical evidence on the relative importance of specific observable factors that can explain why individuals enrolled in both Medicare and Medicaid (duals) are concentrated in lower quality nursing homes, relative to those not on Medicaid. Descriptive results show that duals are 9.7 percentage points more likely than nonduals to be admitted to a low-quality (1-2 stars) nursing home. Using the Blinder-Oaxaca decomposition approach in a multivariate framework, we find that 35.4% of the difference in admission to low-quality nursing homes can be explained by differences in the distribution of observable characteristics. Differences in education and distance to high-quality nursing homes are important drivers, as are health status and race. Our findings highlight the need for creative policy solutions targeting the modifiable factors to reduce the disparity.
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Abstract
BACKGROUND Nursing home (NH) care is financed through multiple sources. Although Medicaid is the predominant payer for NH care, over 20% of residents pay out-of-pocket for their care. Despite this large percentage, an accepted measure of private-pay NH occupancy has not been established and little is known about the types of facilities and the long-term care markets that cater to this population. OBJECTIVES To describe 2 novel measures of private-pay utilization in the NH setting, including the proportion of privately financed residents and resident days, and examine their construct validity. DESIGN Retrospective descriptive analysis of US NHs in 2007-2009. MEASURES We used Medicare claims, Medicare Enrollment records, and the Minimum Data Set to create measures of private-pay resident prevalence and proportion of privately financed NH days. We compared our estimates of private-pay utilization to payer data collected in the NH annual certification survey and evaluated the relationships of our measures with facility characteristics. RESULTS Our measures of private-pay resident prevalence and private-pay days are highly correlated (r=0.83, P<0.001 and r=0.83, P<0.001, respectively) with the rate of "other payer" reported in the annual certification survey. We also observed a significantly higher proportion of private-pay residents and days in higher quality facilities. CONCLUSIONS This new methodology provides estimates of private-pay resident prevalence and resident days. These measures were correlated with estimates using other data sources and validated against measures of facility quality. These data set the stage for additional work to examine questions related to NH payment, quality of care, and responses to changes in the long-term care market.
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Konetzka RT, Grabowski DC, Perraillon MC, Werner RM. Nursing home 5-star rating system exacerbates disparities in quality, by payer source. Health Aff (Millwood) 2016; 34:819-27. [PMID: 25941284 DOI: 10.1377/hlthaff.2014.1084] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Market-based reforms in health care, such as public reporting of quality, may inadvertently exacerbate disparities. We examined how the Centers for Medicare and Medicare Services' five-star rating system for nursing homes has affected residents who are dually enrolled in Medicare and Medicaid ("dual eligibles"), a particularly vulnerable and disadvantaged population. Specifically, we assessed the extent to which dual eligibles and non-dual eligibles avoided the lowest-rated nursing homes and chose the highest-rated homes once the five-star rating system began, in late 2008. We found that both populations resided in better-quality homes over time but that by 2010 the increased likelihood of choosing the highest-rated homes was substantially smaller for dual eligibles than for non-dual eligibles. Thus, the gap in quality, as measured by a nursing home's star rating, grew over time. Furthermore, we found that the benefit of the five-star system to dual eligibles was largely due to providers' improving their ratings, not to consumers' choosing different providers. We present evidence suggesting that supply constraints play a role in limiting dual eligibles' responses to quality ratings, since high-quality providers tend to be located close to relatively affluent areas. Increases in Medicaid payment rates for nursing home services may be the only long-term solution.
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Affiliation(s)
- R Tamara Konetzka
- R. Tamara Konetzka is an associate professor of health services research in the Department of Public Health Sciences at the University of Chicago, in Illinois
| | - David C Grabowski
- David C. Grabowski is a professor of health care policy at Harvard Medical School, in Boston, Massachusetts
| | - Marcelo Coca Perraillon
- Marcelo Coca Perraillon is a PhD candidate in the Department of Public Health Sciences at the University of Chicago
| | - Rachel M Werner
- Rachel M. Werner is an associate professor of medicine at the University of Pennsylvania, in Philadelphia
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Shubing Cai, Mukamel DB, Veazie P, Katz P, Temkin-Greener H. Hospitalizations in nursing homes: does payer source matter? Evidence from New York State. Med Care Res Rev 2011; 68:559-78. [PMID: 21478193 DOI: 10.1177/1077558711399581] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to examine the reasons for different hospitalization rates between Medicaid and private-pay nursing home residents-to disentangle within-facility differences from across-facility variations in hospitalizations between these two types of residents. Multiple data sources (2003) for New York State were linked. Hospitalization was the dependent variable. Individual payer status was the main independent variable. Facilities were stratified into four groups by ownership status and bed-hold payment eligibility. We found both within-facility (Medicaid residents were more likely to be hospitalized than private-pay residents within a facility) and across-facility differences (facilities with a higher concentration of Medicaid residents were more likely to hospitalize their residents) controlling for individual and facility characteristics. The magnitude of within-facility differences varied with facility ownership and bed-hold eligibility. To reduce hospitalizations of Medicaid residents and to improve both quality of care and costs, policymakers may need to align Medicaid's and Medicare's incentives.
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Affiliation(s)
- Shubing Cai
- Center for Gerontology and Health Care Research, The Warren Alpert Medical School, Brown University, Providence, RI 02912, USA.
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Grabowski DC, Feng Z, Intrator O, Mor V. Medicaid bed-hold policy and Medicare skilled nursing facility rehospitalizations. Health Serv Res 2010; 45:1963-80. [PMID: 20403059 DOI: 10.1111/j.1475-6773.2010.01104.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To analyze the effect of states' Medicaid bed-hold policies on the 30-day rehospitalization of Medicare postacute skilled nursing facility (SNF) residents. DATA SOURCES Minimum data set assessments were merged with Medicare claims and eligibility files for all first-time SNF admissions (N = 3,322,088) over the period 2000 through 2005; states' Medicaid bed-hold policies were obtained via survey. STUDY DESIGN Regression specification incorporating facility fixed effects to examine changes in Medicaid bed-hold policies on the likelihood of a 30-day SNF rehospitalization. PRINCIPAL FINDINGS Using a continuous measure of bed-hold generosity, state Medicaid bed-hold was positively related to Medicare SNF rehospitalization. Specifically, the introduction of a bed-hold policy with average generosity increases Medicare rehospitalizations by 1.8 percent, representing roughly 12,000 SNF rehospitalizations at a cost to Medicare of approximately U.S.$100 million over our study period. CONCLUSIONS Although facilities do not receive a Medicaid bed-hold payment for Medicare SNF stays, we found that the adoption of more generous policies led to greater SNF rehospitalizations. This type of spillover is largely ignored in current discussions of Medicare payment reforms such as bundled payment. Neither Medicare nor Medicaid has an incentive to internalize the risks and benefits of its actions as they affect the other.
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Affiliation(s)
- David C Grabowski
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115-5899, USA.
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Cai S, Mukamel DB, Veazie P, Temkin-Greener H. Validation of the Minimum Data Set in identifying hospitalization events and payment source. J Am Med Dir Assoc 2010; 12:38-43. [PMID: 21194658 DOI: 10.1016/j.jamda.2010.02.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 02/02/2010] [Accepted: 02/02/2010] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the accuracy of the Minimum Data Set (MDS) in identifying hospitalization events and payment source among nursing home residents. RESEARCH DESIGN The 2003 MDS, Medicare Provider Analysis and Review File (MedPAR), Medicare denominator file, Medicaid Analytical Extract (MAX) long-term care file, and MAX personal summary file for 4 states (California, Ohio, New York, and Texas) were obtained and merged. SETTING All Medicare/Medicaid-certified nursing ho-mes in these 4 states during 2003. PARTICIPANTS All nursing home residents who were eligible for Medicare. Medicare or Medicaid managed care enrollees were excluded. MEASUREMENTS Using the identification by linking the MDS and claims data as the "gold standard," we calculated false negative and false positive error rates of the MDS in identifying hospitalization events and payment source. RESULTS As for the accuracy of the MDS in identifying hospitalization events, the false negative error rates ranged from 6.8% to 19.5% and the false positive error rates were between 12.0% and 15.7%, depending on the state. With regard to the identification of Medicare payment source, the MDS had a low false negative rate (varying from 0.4% to 1.1%), and a relatively high false positive rate (ranging from 6.1% to 14.9%). The MDS alone did not seem to be a sufficient source for identification of Medicaid payment source (false negative rate ranging from 11.0% to 55.3%). CONCLUSIONS The accuracy of the MDS in identifying hospitalizations and payment sources varies across the study states, and should be evaluated carefully with regard to the intended uses of the data.
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Affiliation(s)
- Shubing Cai
- Center for Gerontology and Health Care Research, The Warren Alpert Medical School, Brown University, Providence, RI 02912, USA.
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Konetzka RT, Werner RM. Disparities in long-term care: building equity into market-based reforms. Med Care Res Rev 2009; 66:491-521. [PMID: 19228634 DOI: 10.1177/1077558709331813] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
A growing body of evidence documents pervasive racial, ethnic, and class disparities in long-term care in the United States. At the same time, major quality improvement initiatives are being implemented that rely on market-based incentives, many of which may have the unintended consequence of exacerbating disparities. We review existing evidence on disparities in the use and quality of long-term care services, analyze current market-based policy initiatives in terms of their potential to ameliorate or exacerbate these disparities, and suggest policies and policy modifications that may help decrease disparities. We find that racial disparities in the use of formal long-term care have decreased over time. Disparities in quality of care are more consistently documented and appear to be related to racial and socioeconomic segregation of long-term care facilities as opposed to within-provider discrimination. Market-based incentives policies should explicitly incorporate the goal of mitigating the potential unintended consequence of increased disparities.
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Affiliation(s)
- R Tamara Konetzka
- Department of Health Studies, University of Chicago, 5841 S. Maryland Avenue, MC2007, Chicago, IL 60637, USA.
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Clement JP, Bradley CJ, Lin C. Organizational characteristics and cancer care for nursing home residents. Health Serv Res 2009; 44:1983-2003. [PMID: 19780848 DOI: 10.1111/j.1475-6773.2009.01024.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We evaluate whether organization, market, policy, and resident characteristics are related to cancer care processes and outcomes for dually eligible residents of Michigan nursing homes who entered facilities without a cancer diagnosis but subsequently developed the disease. DATA SOURCES/STUDY DESIGN/DATA COLLECTION: Using data from the Michigan Tumor Registry (1997-2000), Medicare claims, Medicaid cost reports, and the Area Resource File, we estimate logistic regression models of diagnosis at or during the month of death and receipt of pain medication during the month of or month after diagnosis. PRINCIPAL FINDINGS Approximately 25 percent of the residents were diagnosed at or near death. Only 61 percent of residents diagnosed with late or unstaged cancer received pain medication during the diagnosis month or the following month. Residents in nursing homes with lower staffing and in counties with fewer hospital beds were more likely to be diagnosed at death. After the Balanced Budget Act (BBA), residents were more likely to be diagnosed at death. CONCLUSIONS Nursing home characteristics and community resources are significantly related to the cancer care residents receive. The BBA was associated with an increased likelihood of later diagnosis of cancer.
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Affiliation(s)
- Jan P Clement
- Department of Health Administration, Virginia Commonwealth University, 1008 Clay Street, Richmond, VA 23298-0203, USA
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Decker FH. Outcomes and length of medicare nursing home stays: the role of registered nurses and physical therapists. Am J Med Qual 2009; 23:465-74. [PMID: 19001102 DOI: 10.1177/1062860608324173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Data on Medicare discharges (n = 4,086) in the discharge sample of the National Nursing Home Survey were used to study the association of registered nurse (RN) and physical therapist (PT) staffing levels to the outcomes and length of Medicare nursing home stays. Marginal effects were calculated in multinomial logistic modeling of Medicare beneficiaries who recovered/stabilized, died, or were hospitalized. Linear regression models on length of stay (LOS) were constructed. Higher RN staffing was related to fewer hospitalizations whereas greater PT staffing was associated with more recovered/stabilized outcomes and fewer deaths. RN and PT staffing may play different, though complementary, clinical roles affecting outcomes. Higher RN and PT staffing levels also reduced LOS of recovered/stabilized outcomes. The staffing increases involved in reducing LOS and hospitalizations appear substantial. Research on best practices that can amplify effects of nursing home staffing increases on quality seem to be the next step to further quality improvement.
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Affiliation(s)
- Frederic H Decker
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland 20782, USA.
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Kirkevold Ø, Engedal K. Quality of care in Norwegian nursing homes - deficiencies and their correlates. Scand J Caring Sci 2008; 22:560-7. [DOI: 10.1111/j.1471-6712.2007.00575.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Grabowski DC, Gruber J, Angelelli JJ. Nursing Home Quality as a Common Good. THE REVIEW OF ECONOMICS AND STATISTICS 2008; 90:754-764. [PMID: 20463859 PMCID: PMC2867608 DOI: 10.1162/rest.90.4.754] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A long-standing assumption among economists is that nursing home quality is common across Medicaid and private-pay patients within a shared facility. However, there has been only limited empirical work addressing this issue. Using a unique individual level panel of residents of nursing homes from seven states, we exploit both within-facility and within-person variation in payer source and quality to examine this issue. We also test the robustness of these results across states with different Medicaid and private-pay rate differentials. Across various identification strategies, our results are consistent with the assumption of common quality across Medicaid and private-paying patients within facilities.
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Affiliation(s)
- David C. Grabowski
- Corresponding author. Tel: 617-432-3369; Fax: 617-432-3435; ; Address: Department of Health Care Policy, 180 Longwood Avenue, Boston, MA 02115-5899, USA
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Grabowski DC. The market for long-term care services. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2008; 45:58-74. [PMID: 18524292 DOI: 10.5034/inquiryjrnl_45.01.58] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although a large literature has established the importance of market and regulatory forces within the long-term care sector, current research in this field is limited by a series of data, measurement, and methodological issues. This paper provides a comprehensive review of these issues with an emphasis on identifying initiatives that will increase the volume and quality of long-term care research. Recommendations include: the construction of standard measures of long-term care market boundaries, the broader dissemination of market and regulatory data, the linkage of survey-based data with market measures, the encouragement of further market-based studies of noninstitutional long-term care settings, and the standardization of Medicaid cost data.
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Affiliation(s)
- David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115-5899, USA.
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The relationship of nursing staff to the hospitalization of nursing home residents. Res Nurs Health 2008; 31:238-51. [DOI: 10.1002/nur.20249] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Decker FH. Dying in a nursing home: the role of local bed supply in nursing home discharges. J Aging Health 2007; 20:66-88. [PMID: 18042962 DOI: 10.1177/0898264307309935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The relationship of nursing home (NH) discharges due to death to NH bed supply and hospital bed supply was examined. METHOD Data on discharges came from the 1999 National Nursing Home Survey (N = 6,335). County-level bed supply, controls for hospice agency supply, and a nursing facility's percentage of area NH beds came from the Area Resource File. Multinomial logistic regression was used to compare deaths with live discharges. Marginal effects were calculated. RESULTS Discharges due to death increased with increasing NH bed supply and decreased in areas with greater hospital bed supply, areas where hospitalizations were more likely. Hospice supply and a facility's share of area NH beds also affected the probability of discharges due to death. DISCUSSION Supply factors appear related to discharge decisions in a manner affecting the probability of discharges due to death, although the magnitude of the relationship may be less than expected.
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Intrator O, Grabowski DC, Zinn J, Schleinitz M, Feng Z, Miller S, Mor V. Hospitalization of nursing home residents: the effects of states' Medicaid payment and bed-hold policies. Health Serv Res 2007; 42:1651-71. [PMID: 17610442 PMCID: PMC1955269 DOI: 10.1111/j.1475-6773.2006.00670.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Hospitalizations of nursing home residents are costly and expose residents to iatrogenic disease and social and psychological harm. Economic constraints imposed by payers of care, predominantly Medicaid policies, are hypothesized to impact hospitalizations. DATA SOURCES/STUDY SETTING Federally mandated resident assessments were merged with Medicare claims and eligibility files to determine hospitalizations and death within 150 days of baseline assessment. Nursing home and market characteristics were obtained from the Online Survey Certification and Reporting, and the Area Resource File, respectively. States' average daily Medicaid nursing home payments and bed-hold policies were obtained independently. STUDY DESIGN Prospective cohort study of 570,614 older (> or =65-year-old), non-MCO (Medicare Managed Care), long-stay (> or =90 days) residents in 8,997 urban, freestanding nursing homes assessed between April and June 2000, using multilevel models to test the impact of state policies on hospitalizations controlling for resident, nursing home, and market characteristics. PRINCIPAL FINDINGS Overall, 99,379 (17.4 percent) residents were hospitalized with rates varying from 8.4 percent in Utah to 24.9 percent in Louisiana. Higher Medicaid per diem was associated with lower odds of hospitalizations (5 percent lower for each $10 above average $103.5, confidence intervals [CI] 0.91-0.99). Hospitalization odds were higher by 36 percent in states with bed-hold policies (CI: 1.12-1.63). CONCLUSIONS State Medicaid bed-hold policy and per-diem payment have important implications for nursing home hospitalizations, which are predominantly financed by Medicare. This study emphasizes the importance of properly aligning state Medicaid and federal Medicare policies in regards to the subsidy of acute, maintenance, and preventive care in the nursing home setting.
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Affiliation(s)
- Orna Intrator
- Brown University, Box G-ST2, Providence, RI 02912, USA
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Intrator O, Grabowski DC, Zinn J, Schleinitz M, Feng Z, Miller S, Mor V. Hospitalization of nursing home residents: the effects of states' Medicaid payment and bed-hold policies. Health Serv Res 2007. [PMID: 17610442 DOI: 10.1111/j.1475‐6773.2006.00670.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Hospitalizations of nursing home residents are costly and expose residents to iatrogenic disease and social and psychological harm. Economic constraints imposed by payers of care, predominantly Medicaid policies, are hypothesized to impact hospitalizations. DATA SOURCES/STUDY SETTING Federally mandated resident assessments were merged with Medicare claims and eligibility files to determine hospitalizations and death within 150 days of baseline assessment. Nursing home and market characteristics were obtained from the Online Survey Certification and Reporting, and the Area Resource File, respectively. States' average daily Medicaid nursing home payments and bed-hold policies were obtained independently. STUDY DESIGN Prospective cohort study of 570,614 older (> or =65-year-old), non-MCO (Medicare Managed Care), long-stay (> or =90 days) residents in 8,997 urban, freestanding nursing homes assessed between April and June 2000, using multilevel models to test the impact of state policies on hospitalizations controlling for resident, nursing home, and market characteristics. PRINCIPAL FINDINGS Overall, 99,379 (17.4 percent) residents were hospitalized with rates varying from 8.4 percent in Utah to 24.9 percent in Louisiana. Higher Medicaid per diem was associated with lower odds of hospitalizations (5 percent lower for each $10 above average $103.5, confidence intervals [CI] 0.91-0.99). Hospitalization odds were higher by 36 percent in states with bed-hold policies (CI: 1.12-1.63). CONCLUSIONS State Medicaid bed-hold policy and per-diem payment have important implications for nursing home hospitalizations, which are predominantly financed by Medicare. This study emphasizes the importance of properly aligning state Medicaid and federal Medicare policies in regards to the subsidy of acute, maintenance, and preventive care in the nursing home setting.
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Affiliation(s)
- Orna Intrator
- Brown University, Box G-ST2, Providence, RI 02912, USA
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Abstract
BACKGROUND Findings on the relationship between nurse staffing and nursing home outcomes (eg, dying vs. discharges to the community) have been inconsistent. Although some studies show outcomes related to staffing ratios, others do not. Subjects in studies showing staffing effects may have been primarily short-stay residents and longer stays in studies showing no staffing effects. Outcomes affected by staffing may vary by short and longer stays. OBJECTIVE The effect of staffing by duration of stay has not been studied explicitly. The purpose of this study was to discern whether the effect of nursing staffing on discharge status varies between short and longer stays. METHOD Data on discharges came from the 1999 National Nursing Home Survey (n = 6386). Models were constructed for short and longer stays applying multinomial logistic regression. RESULTS For stays less than 60 days, but not among longer stays, the probability of leaving the nursing home in recovered or stabilized condition increased, and that of dying decreased, with an increasing staffing ratio for registered nurses. Clinical condition was the major factor differentiating discharge status among short and longer stays. CONCLUSION Results indicate a likely reason for past inconsistent findings on staffing. Staffing ratios may affect discharge disposition more among short stays. Some discharge dispositions, such as death, may not be the most relevant outcomes to study to discern how staffing affects the care provided to longer-stay residents. More research is warranted on how the sensitivity of outcomes to staffing ratios varies across short- and longer-stay residents.
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Affiliation(s)
- Frederic H Decker
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland 20872, USA.
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Abstract
BACKGROUND Promoting the quality of life is an importing aim of the long-term care for the elderly, and the quality of life is related to quality of care (QoC). This way the QoC in nursing homes, and its correlates, is an interesting subject. AIM To describe to what degree Norwegian nursing homes provide services in line with the core areas of the 'regulation of care' and whether patient or ward characteristics are associated with the QoC. METHODS AND MATERIAL Cross-sectional study where data were collected in structured interview of the nursing staff in 251 wards regarding 1926 patients. RESULTS Most of the patients receive good basic care in Norwegian nursing homes, but taking part in leisure activities and having the opportunity to go out for a walk are more often neglected. Acceptable QoC had a strongly negative association with patient characteristics such as low function in mental capacity, low function in activities of daily living and aggressive behaviour. In most of the measured areas of QoC, ward characteristics, such as type of ward, size of ward and staffing ratio, do have an influence on QoC.
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Affiliation(s)
- Oyvind Kirkevold
- Norwegian Centre for Dementia Research, Vestfold Mental Health Care Trust, Tønsberg, SEM, Norway.
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Sicras Mainar A, Peláez de Loño J. Mejora de la adecuación de uso de medicamentos y efectos en centros geriátricos mediante un programa de intervención. FARMACIA HOSPITALARIA 2005; 29:303-11. [PMID: 16351451 DOI: 10.1016/s1130-6343(05)73684-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To evaluate the impact of a program for increasing adequacy of drug prescriptions in a group of nursing homes 2 years after implementation. METHOD This quasi-experimental before and after study was carried out with a control group in various centers. It included all outpatient prescriptions, individualized by centre, during the study period (reference: year 2001 and post-intervention: year 2003) with 107/118 nursing homes from the Región Sanitaria del Barcelonés Norte y Maresme (Barcelona) included in each period. After an initial situation analysis, centers were assigned to two different groups: intervention group (n = 32) and control group (n = 75/86). Number of residents: 4,798/5,816 (years: 2001/2003). Actions accomplished in the intervention group were: a) presentation letter, b) informative interview c) management control and d) monitorization with follow-up interviews. Quantitative (total cost of drugs among residents) and qualitative indicators (high intrinsic pharmacologic value drug use, generic drug use and super-night diaper use) were established as measurement units, together with relative use values. RESULTS In the intervention group, cost contention was evident. Cost per resident was 1,671.89 EUR +/- 458.33 EUR in the reference period and 1,821.22 EUR +/- 311.88 EUR during the post-intervention period (inter-annual increment of 8.9% vs. 19.5% compared to the control group; p = 0.002). Number of packages per resident showed an inter-annual increment of 2.5% and 11.4% (p = 0.001) respectively. An increased use of generic drugs (7.9% and 18.4%), antiasthmatic agents, omeprazol and recommended nonsteroidal antiinflammatory agents was observed; while there were no differences in the use of antidepressants and antibiotics. CONCLUSIONS The preliminary results have shown improved efficiency of pharmaceutical prescriptions in nursing homes included in the intervention group. The methodology used appears to be appropriate for promoting rational use of drugs and improving prescription quality.
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Affiliation(s)
- A Sicras Mainar
- Unidad de Farmacia, Región Sanitaria de Barcelonés Norte y Maresme, Badalona, Barcelona.
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