Quality of care in nursing homes - An analysis of relationships among profit, quality, and ownership
Quality of care in nursing homes - An analysis of relationships among profit, quality, and ownership
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DOI：
10.1097/01.mlr.0000100586.33970.58
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发表时间：
2003-12-01
期刊：
影响因子：
3
通讯作者：
Saliba, D
中科院分区：
文献类型：
--
作者：
O'Neill, C;Harrington, C;Saliba, D
背景。最近的工作强调了专利状态和养老院护理质量之间的负相关关系。这种关系可以用私有住宅的经营环境来解释。然而，另一种可能的解释是，一些私人疗养院攫取了过多的利润，而损害了护理质量。在考虑居民和市场特征的情况下，研究世界卫生组织专有和非专有养老院的利润水平与质量之间的关系。1098个独立NHs的数据来自加州全州卫生规划和发展办公室、在线调查认证和报告系统以及1998年和1999年的加州许可和统计报告。多变量技术被用来检验缺陷引用和一系列解释变量（包括利润）之间的关系。加州私有家庭的护理质量明显低于非私有家庭。一项分层分析显示，在控制居民、设施和市场特征的情况下，位于专有部门利润分配中最高的14%的利润与显著更多的总缺陷和严重缺陷相关。在非专有设施中没有发现这种关系。与缺陷相关的其他因素包括居民的种族混合和设施规模。在私有房屋经营的背景下，高于给定阈值的利润与更高数量的缺陷相关。考虑到这一点和专利部门在NH护理中的作用，仔细监测该部门的利润水平似乎是有必要的。
BACKGROUND. Recent work has highlighted a negative correlation between proprietary status and nursing home quality of care. This relationship might be explained by the context in which proprietary homes operate. However, another possible explanation is that some proprietary homes take excessive profit to the detriment of care quality.OBJECTIVE. To examine the relationship between profit levels and quality in proprietary and nonproprietary nursing homes WHO, accounting for resident and market characteristics.METHODS. Data on 1098 free-standing NHs were taken from the California Office of Statewide Health Planning and Development, the On-line Survey Certification and Reporting System, and California licensing and statistical reports for 1998 and 1999. Tobit multivariate techniques were used to examine the relationship between deficiency citations and a range of explanatory variables, including profit.RESULTS. Proprietary homes in California had significantly lower quality of care than nonproprietary homes. A stratified analysis revealed that, controlling for resident, facility, and market characteristics, profits located within the highest 14% of the proprietary sector's profit distribution were associated with significantly more total deficiencies and serious deficiencies. This relationship was not found in nonproprietary facilities. Other factors related to deficiencies included the ethnic mix of residents and facility size.CONCLUSIONS. Within the context in which proprietary homes operate, profit above a given threshold is associated with a higher number of deficiencies. Given this and the role of the proprietary sector in NH care, careful monitoring of profit levels in this sector appears warranted.