Is There Evidence of Cream Skimming Among Nursing Homes Following the Publication of the Nursing Home Compare Report Card?
Is There Evidence of Cream Skimming Among Nursing Homes Following the Publication of the Nursing Home Compare Report Card?
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DOI：
10.1093/geront/gnp062
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发表时间：
2009-12-01
期刊：
影响因子：
5.7
通讯作者：
Zinn, Jacqueline S.
中科院分区：
文献类型：
--
作者：
Mukamel, Dana B.;Ladd, Heather;Zinn, Jacqueline S.
目的：自2002年以来，一直发布全国疗养院质量报告卡《疗养院比较》。它已被证明对护理质量有一些积极的影响，尽管有限。本研究的目的是实证检验的假设，养老院已采取奶油撇取入场政策的报告的出版作出回应。设计和方法：该研究包括2001-2005年期间全国所有医疗保险和医疗补助认证的疗养院的所有非医疗保险新入院患者。使用最小数据集数据，我们计算了每个季度的几个入院队列特征：日常生活活动限制的平均数量以及因疼痛，压疮，尿失禁，糖尿病和记忆力限制而入院的居民百分比。我们通过估计固定设施效应纵向回归模型，测试了在出版后住院的居民是否比在出版前住院的居民更少虚弱和生病。按养老院所有权、入住率、报告质量排名、连锁关系和地区进行分层分析。结果如下：在疼痛方面发现了撇脂的证据，在较小程度上，在记忆限制方面，但在其他4个入院队列特征方面没有发现撇脂的证据。影响：尽管理论预期，经验证据表明，只有有限程度的奶油撇除。需要进一步的研究来调查这种现象与其他入院队列特征和急性期后患者。
Purpose: A national quality report card for nursing homes, Nursing Home Compare, has been published since 2002. It has been shown to have some, albeit limited, positive impact on quality of care. The objective of this study was to test empirically the hypothesis that nursing homes have responded to the publication of the report by adopting cream skimming admission policies. Design and Methods: The study included all non-Medicare newly admitted patients to all Medicare- and Medicaid-certified nursing homes nationally during the 2001-2005 period. Using the Minimum Data Set data, we calculated for each quarter several admission cohort characteristics: average number of activity of daily living limitations and percent of residents admitted with pain, with pressure ulcers, with urinary incontinence, with diabetes, and with memory limitations. We tested whether residents admitted in the postpublication period were less frail and sick compared with residents admitted in the prepublication period by estimating fixed facility effects longitudinal regression models. Analyses were stratified by nursing home ownership, occupancy, reported quality ranking, chain affiliation, and region. Results: Evidence for cream skimming was found with respect to pain and, to a lesser degree, with respect to memory limitation but not with respect to the 4 other admission cohort characteristics. Implications: Despite the theoretical expectation, empirical evidence suggests only a limited degree of cream skimming. Further studies are required to investigate this phenomenon with respect to other admission cohort characteristics and with respect to post-acute patients.