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Jin X, Uda K, Ishimaru M, Kihara T, Sugiyama T, Yamagishi K, Iso H, Tamiya N. The Effect of Business Operating Systems on Nursing Home Termination. Int J Public Health 2023; 68:1605439. [PMID: 36816835 PMCID: PMC9928747 DOI: 10.3389/ijph.2023.1605439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/18/2023] [Indexed: 02/04/2023] Open
Abstract
Objectives: Nursing home terminations have increased worldwide due to rising costs, staffing shortages, and the coronavirus disease pandemic. However, little is known about the impact that business operating systems have on nursing home termination. Methods: This study used the National Long-term Care database, which comprised 7,842 operating nursing homes in January 2018. Nursing home termination was identified when nursing homes discontinued provision of long-term care services to all residents between January 2018 and December 2020. Business operating systems that were reimbursed by the LTC insurance system were the exposure of interest. The logistic regression model for nursing home termination included a series of organizational, internal, and external factors as covariates. Results: From 2018 to 2020, 83 (1.1%) nursing homes were terminated. The proportion of reimbursed nursing homes varied greatly depending on the type of business operating systems. Implementing physical function training and improving working conditions were significantly associated with a lower risk of nursing home termination. Conclusion: Financial incentives to several business operating systems are an effective way to build a sustainable environment for nursing homes to continue to exist.
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Affiliation(s)
- Xueying Jin
- Department of Social Science, National Center for Geriatrics and Gerontology, Obu, Japan,Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan,*Correspondence: Xueying Jin,
| | - Kazuaki Uda
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Miho Ishimaru
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan,Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomomi Kihara
- Department of Public Health Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takehiro Sugiyama
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan,Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan,Institute for Global Health Policy, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan,Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroyasu Iso
- Institute for Global Health Policy, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Nanako Tamiya
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan,Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
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Ibrahim K, Baron S, Lathlean J, Bridges J, McGrath N, Roberts HC. Moving our care home: A qualitative study of the views and experiences of residents, relatives and staff. Int J Older People Nurs 2022; 17:e12466. [PMID: 35437921 PMCID: PMC9788319 DOI: 10.1111/opn.12466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 10/04/2021] [Accepted: 03/18/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Involuntary relocation when care homes close can be detrimental to residents' health and well-being and is associated with increased mortality. There is little formal evidence to support whether planning can mitigate the impact of such moves. This study aimed to understand the experiences of a whole care home relocation where staff and residents relocated together using existing published guidance. METHODS A longitudinal qualitative research study using individual face-to-face semi-structured interviews was conducted between August 2018 and August 2019. Baseline interviews were conducted 6-8 weeks after relocation with follow-up interviews 10-12 months later. Interviews were recorded, transcribed and analysed using framework analysis. RESULTS 27 interviews were conducted; 19 baseline interviews (4 residents, 7 family members, 8 staff) and 8 follow-up interviews (2 residents, 2 family members, 4 staff). Participants' feelings about the relocation were mixed: some reported apprehension before the move but others excitement. Residents and families felt variably involved in planning the move, whereas staff expressed lack of involvement. Time, family support and continuity of care helped participants settle in. The new environment shaped participants' experiences and abilities to adjust, especially the lack of a homely feeling with the new home, the larger size and changes in staff organisation and management. CONCLUSIONS Despite implementation of existing guidance, relocation was still challenging for residents, staff and family members. Future relocations should increase involvement of staff in the planning and design of the home; offer continuous support to those involved; and ensure continuity of care and management style.
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Affiliation(s)
- Kinda Ibrahim
- Academic Geriatric MedicineFaculty of MedicineUniversity of SouthamptonSouthamptonUK,NIHR Applied Research Collaboration WessexUniversity of SouthamptonSouthamptonUK
| | - Sophie Baron
- Academic Geriatric MedicineFaculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Judith Lathlean
- Primary Care, Population Sciences and Medical EducationFaculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Jackie Bridges
- NIHR Applied Research Collaboration WessexUniversity of SouthamptonSouthamptonUK,Faculty of Environmental and Life SciencesSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Nuala McGrath
- NIHR Applied Research Collaboration WessexUniversity of SouthamptonSouthamptonUK,Primary Care, Population Sciences and Medical EducationFaculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Helen C. Roberts
- Academic Geriatric MedicineFaculty of MedicineUniversity of SouthamptonSouthamptonUK,NIHR Applied Research Collaboration WessexUniversity of SouthamptonSouthamptonUK,University of Southampton and University Hospital Southampton NHS FTSouthamptonUK,NIHR Southampton Biomedical Research Centre (BRC)SouthamptonUK
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Weaver RH, Roberto KA, Brossoie N. A Scoping Review: Characteristics and Outcomes of Residents Who Experience Involuntary Relocation. THE GERONTOLOGIST 2020; 60:e20-e37. [PMID: 31112600 DOI: 10.1093/geront/gnz035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Relocation to a residential care facility has been described as the most significant relocation affecting older adults, yet subsequent relocations, like in the case of a facility closure, have received minimal attention in the scholarly research literature. This paper reviews the published literature on involuntary relocation, focusing on the experiences of residents, families, and staff and the effects of involuntary relocation on nursing home residents' health. RESEARCH DESIGN AND METHODS We conducted a scoping review to identify peer-reviewed studies reporting on involuntary relocation of nursing home residents. A total of 28 quantitative, qualitative, and mixed-method articles met inclusion criteria. RESULTS Researchers mostly relied on longitudinal designs and quantitative indicators of functional health, cognitive status, psychological and emotional well-being, environment, and relocation context to examine residents' mortality risk and health outcomes associated with involuntary relocation. Inclusion of qualitative and mixed-method approaches was infrequent, as were indicators of social engagement and perceptions of relocation. Residents' awareness of and preparation for involuntary relocation positively influenced their health and well-being. Family involvement was frequently hindered by communication challenges with facilities. Staff expressed concern about residents, experienced increased workload demands, and acknowledged challenges with planning and communication. DISCUSSION AND IMPLICATIONS Based on the collective findings, we propose a conceptual model of critical factors at play during relocation for consideration for guiding future research and developing provisions to current policies guiding relocation processes. Facilities and policymakers need to consider procedures that enhance planning efforts and decision-making among this vulnerable population and their families.
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Affiliation(s)
- Raven H Weaver
- Department of Human Development, Washington State University, Pullman
| | - Karen A Roberto
- Institute for Society, Culture and Environment.,Center for Gerontology, Virginia Tech, Blacksburg
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Cheon O, Baek J, Kash BA, Jones SL. An exploration of community partnerships, safety-net hospitals, and readmission rates. Health Serv Res 2020; 55:531-540. [PMID: 32249423 DOI: 10.1111/1475-6773.13287] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To compare hospital-community partnerships among safety-net hospitals relative to non-safety-net hospitals, and explore whether hospital-community partnerships are associated with reductions in readmission rates. DATA SOURCES Data from four nationwide hospital-level datasets for 2015-2016, including American Hospital Association (AHA) annual survey, Hospital Inpatient Prospective Payment System (IPPS) data, CMS Hospital Compare, and County Health Rankings National (CHRN) data. STUDY DESIGN We first examined how safety-net hospitals partner with nine different community providers, and how the overall and individual partnership patterns differ from those in non-safety-net hospitals. We then explored their association with 30-day readmission rates by diagnosis and hospital wide. DATA COLLECTION/EXTRACTION METHODS We included 1979 hospitals across 50 US states. PRINCIPAL FINDINGS Safety-net hospitals were more engaged in hospital-community partnerships, especially with local public health, local governments, social services, nonprofits, and insurance companies, relative to their non-safety-net peers. However, we found that such partnerships were not significantly related to reductions in readmission rates. The findings indicated that merely partnering with various community organizations may not be associated with readmission rate reduction. CONCLUSIONS Before promoting partnerships with various community organizations for its own sake, further prospective, longitudinal, and evidence-based guidance derived from the study of hospital-community partnerships is needed to make meaningful recommendations aimed at readmission rate reduction in safety-net hospitals.
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Affiliation(s)
- Ohbet Cheon
- David D. Reh School of Business, Clarkson University, Schenectady, New York.,Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Juha Baek
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas.,School of Public Health, Texas A&M University, College Station, Texas
| | - Bita A Kash
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas.,School of Public Health, Texas A&M University, College Station, Texas.,NSF Center for Health Organization Transformation, Texas A&M University, College Station, Texas
| | - Stephen L Jones
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas.,Weill Cornell Medical College, Cornell University, New York, New York
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Fisher A, Castle N. Why do nursing homes close? An analysis of newspaper articles. SOCIAL WORK IN PUBLIC HEALTH 2012; 27:409-423. [PMID: 22873933 DOI: 10.1080/19371910903182823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Using Non-numerical Unstructured Data Indexing Searching and Theorizing (NUD'IST) software to extract and examine keywords from text, the authors explored the phenomenon of nursing home closure through an analysis of 30 major-market newspapers over a period of 66 months (January 1, 1999 to June 1, 2005). Newspaper articles typically represent a careful analysis of staff impressions via interviews, managerial perspectives, and financial records review. There is a current reliance on the synthesis of information from large regulatory databases such as the Online Survey Certification And Reporting database, the California Office of Statewide Healthcare Planning and Development database, and Area Resource Files. Although such databases permit the construction of studies capable of revealing some reasons for nursing home closure, they are hampered by the confines of the data entered. Using our analysis of newspaper articles, the authors are able to add further to their understanding of nursing home closures.
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Affiliation(s)
- Andrew Fisher
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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De Bellis A, Mosel K, Curren D, Prendergast J, Harrington A, Muir-Cochrane E. Education on physical restraint reduction in dementia care: a review of the literature. DEMENTIA 2011; 12:93-110. [PMID: 24336665 DOI: 10.1177/1471301211421858] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dementia is a priority area for all countries as populations age and dementia prevalence increases. The use of physical restraint is a possible clinical practice for persons with dementia across settings when behaviours indicate a perceived need. Indeed, this may be the first choice in practice, occurring in part because of lack of education, safety concerns, perceived costs and staffing issues. This article reviews the literature on the issues surrounding, and use of, physical restraint for people with dementia, highlighting the rationales for use and the benefits and barriers to physical restraint. Recommendations include the importance of education and policy to reduce or eliminate physical restraint of persons with dementia to overcome identified barriers at the individual, cultural and organizational levels. An educational programme from the literature review is proposed specific to the reduction or elimination of physical restraint.
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Feng Z, Lepore M, Clark MA, Tyler D, Smith DB, Mor V, Fennell ML. Geographic concentration and correlates of nursing home closures: 1999-2008. ACTA ACUST UNITED AC 2011; 171:806-13. [PMID: 21220642 DOI: 10.1001/archinternmed.2010.492] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND While demographic shifts project an increased need for long-term care for an aging population, hundreds of nursing homes close each year. We examine whether nursing home closures are geographically concentrated and related to local community characteristics such as the racial and ethnic population mix and poverty. METHODS National Online Survey Certification and Reporting data were used to document cumulative nursing facility closures over a decade, 1999 through 2008. Census 2000 zip code level demographics and poverty rates were matched to study facilities. The weighted Gini coefficient was used to measure geographic concentration of closures, and geographic information system maps to illustrate spatial clustering patterns of closures. Changes in bed supply due to closures were examined at various geographic levels. RESULTS Between 1999 and 2008, a national total of 1776 freestanding nursing homes closed (11%), compared with 1126 closures of hospital-based facilities (nearly 50%). Combined, there was a net loss of over 5% of beds. The relative risk of closure was significantly higher in zip code areas with a higher proportion of blacks or Hispanics or a higher poverty rate. The weighted Gini coefficient for closures was 0.55 across all metropolitan statistical areas and 0.71 across zip codes. Closures tended to be spatially clustered in minority-concentrated zip codes around the urban core, often in pockets of concentrated poverty. CONCLUSIONS Nursing home closures are geographically concentrated in minority and poor communities. Since nursing home use among the minority elderly population is growing while it is declining among whites, these findings suggest that disparities in access will increase.
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Affiliation(s)
- Zhanlian Feng
- Center for Gerontology & Health Care Research, Brown University, Providence, RI 02912, USA.
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Li Y, Harrington C, Spector WD, Mukamel DB. State regulatory enforcement and nursing home termination from the medicare and medicaid programs. Health Serv Res 2010; 45:1796-814. [PMID: 20819106 DOI: 10.1111/j.1475-6773.2010.01164.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Nursing homes certified by the Medicare and/or Medicaid program are subject to federally mandated and state-enforced quality and safety standards. We examined the relationship between state quality enforcement and nursing home terminations from the two programs. STUDY DESIGN Using data from a survey of state licensure and certification agencies and other secondary databases, we performed bivariate and multivariate analyses on the strength of state quality regulation in 2005, and nursing home voluntary terminations (decisions made by the facility) or involuntary terminations (imposed by the state) in 2006-2007. PRINCIPAL FINDINGS Involuntary terminations were rarely imposed by state regulators, while voluntary terminations were relatively more common (2.16 percent in 2006-2007) and varied considerably across states. After controlling for facility, market, and state covariates, nursing homes in states implementing stronger quality enforcement were more likely to voluntarily terminate from the Medicare and Medicaid programs (odds ratio = 1.53, p = .018). CONCLUSIONS Although involuntary nursing home terminations occurred rarely in most states, nursing homes in states with stronger quality regulations tend to voluntarily exit the publicly financed market. Because of the consequences of voluntary terminations on patient care and access, state regulators need to consider the effects of increased enforcement on both enhanced quality and the costs of termination.
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Affiliation(s)
- Yue Li
- Department of Internal Medicine, University of Iowa & Iowa City VA Medical Center, SE610 GH, 200 Hawkins Dr, Iowa City, IA 52242, USA.
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Abstract
PURPOSE We determine the rate of nursing home closures for 7 years (1999-2005) and examine internal (e.g., quality), organizational (e.g., chain membership), and external (e.g., competition) factors associated with these closures. DESIGN AND METHOD The names of the closed facilities and dates of closure from state regulators in all 50 states were obtained. This information was linked to the Online Survey, Certification, and Reporting data, which contains information on internal, organizational, and market factors for almost all nursing homes in the United States. RESULTS One thousand seven hundred and eighty-nine facilities closed over this time period (1999-2005). The average annual rate of closure was about 2 percent of facilities, but the rate of closure was found to be increasing. Nursing homes with higher rates of deficiency citations, hospital-based facilities, chain members, small bed size, and facilities located in markets with high levels of competition were more likely to close. High Medicaid occupancy rates were associated with a high likelihood of closure, especially for facilities with low Medicaid reimbursement rates. IMPLICATIONS As states actively debate about how to redistribute long-term care services/dollars, our findings show that they should be cognizant of the potential these decisions have for facilitating nursing home closures.
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Affiliation(s)
- Nicholas G Castle
- Graduate School of Public Health, University of Pittsburgh,Pittsburgh, PA 15261, USA.
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Abstract
Using physical restraints, urethral catheterization, pressure ulcers, psychotropic medication use, and contractures as quality indicators, this research examines whether the quality of nursing homes is associated with private-pay census. The primary data source was the 2000, 2001, and 2002 Online Survey Certification And Recording (OSCAR) data, which is nationally representative data containing information for approximately 17,000 nursing homes. The results of this study suggest that physical restraint use and psychotropic medication use have both a correlative and predictive relationship with private-pay census. Catheterization, pressure ulcers, and contractures are less important. The results of this study are important in two ways. First, the cross-sectional results show that the higher quality nursing homes are likely to have a higher private-pay census. Second, the change score analyses show that nursing homes can increase their private-pay census by increasing quality.
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Affiliation(s)
- Andrea Gruneir
- Department of Community Health, Brown University, Providence, Rhode Island 02912; ,
| | - Vincent Mor
- Department of Community Health, Brown University, Providence, Rhode Island 02912; ,
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Amirkhanyan AA, Kim HJ, Lambright KT. Does the public sector outperform the nonprofit and for-profit sectors? Evidence from a national panel study on nursing home quality and access. JOURNAL OF POLICY ANALYSIS AND MANAGEMENT : [THE JOURNAL OF THE ASSOCIATION FOR PUBLIC POLICY ANALYSIS AND MANAGEMENT] 2008; 27:326-353. [PMID: 18496917 DOI: 10.1002/pam.20327] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Are public and private organizations fundamentally different? This question has been among the most enduring inquiries in public administration. Our study explores the impact of organizational ownership on two complementary aspects of performance: service quality and access to services for impoverished clients. Derived from public management research on performance determinants and nursing home care literature, our hypotheses stipulate that public, nonprofit, and for-profit nursing homes use different approaches to balance the strategic tradeoff between two aspects of performance. Panel data on 14,423 facilities were analyzed to compare measures of quality and access across three sectors using different estimation methods. Findings indicate that ownership status is associated with critical differences in both quality and access. Public and nonprofit organizations are similar in terms of quality, and both perform significantly better than their for-profit counterparts. When compared to nonprofit and, in some cases, for-profit facilities, public nursing homes have a significantly higher share of Medicaid recipients. The paper proposes strategies to address the identified long-term care divide.
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Affiliation(s)
- Anna A Amirkhanyan
- Department of Public Administration and Policy, American University, USA
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Castle NG, Engberg J, Liu D. Have Nursing Home Compare quality measure scores changed over time in response to competition? Qual Saf Health Care 2007; 16:185-91. [PMID: 17545344 PMCID: PMC2465007 DOI: 10.1136/qshc.2005.016923] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Currently, the Centers for Medicare and Medicaid Services report on 15 Quality Measures (QMs) on the Nursing Home Compare (NHC) website. It is assumed that nursing homes are able to make improvements on these QMs, and in doing so they will attract more residents. In this investigation, we examine changes in QM scores, and whether competition and/or excess demand have influenced these change scores over a period of 1 year. METHODS Data come from NHC and the On-line Survey Certification And Recording (OSCAR) system. QM change scores are calculated using values from January 2003 to January 2004. A series of regression analyses are used to examine the association of competition and excess demand on QM scores. RESULTS Eight QMs show an average decrease in scores (ie, better quality) and six QMs show an average increase in scores (ie, worse quality). However, for 13 of the 14 QMs these average changes averaged less than 1%. The regression analyses show an association between higher competition and improving QM scores and an association between lower occupancy and improving QM scores. CONCLUSION As would be predicted based on the market-driven mechanism underlying quality improvements using report cards, we show that it is in the most competitive markets and those with the lowest average occupancy rates that improvements in the QM scores are more likely.
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Abstract
PURPOSE We first describe which states have produced nursing home report cards; second, we compare what information is provided in these report cards; third, we identify data sources used to produce the report cards; and, finally, we examine seven factors previously shown to be associated with the usefulness of report-card information and provide several examples from current reporting efforts to illustrate how nursing home report cards could be improved. DESIGN AND METHODS We searched the Web sites for each state agency responsible for elder affairs-nursing homes. For those states identified as having a nursing home report card, we further examined the information presented. RESULTS We identified 19 states as having nursing home report cards (AZ, CO, FL, IL, IN, IO, MD, MA, MS, NV, NJ, NY, OH, PA, RI, TX, UT, VT, and WI). The information presented in these report cards differs quite substantially across states, although the data sources for report cards do not differ substantially. How the information is presented and our evaluation of the usefulness of the information is also highly varied. IMPLICATIONS Providing nursing home report-card information may be important in helping elders and their families choose a nursing facility. With 19 states identified in our research as providing nursing home report-card information on the World Wide Web, we were surprised and encouraged at this number of initiatives. We give some insight into the kinds of information that can be found on these report cards and what steps could be taken to improve how the information is presented.
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Affiliation(s)
- Nicholas G Castle
- University of Pittsburgh, Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, PA 15261, USA.
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