Does investor-ownership of nursing homes compromise the quality of care?
Does investor-ownership of nursing homes compromise the quality of care?
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DOI：
10.2190/ebcn-wecv-c0nt-676r
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发表时间：
2002-01-01
影响因子：
3.4
通讯作者：
Himmelstein, DU
中科院分区：
文献类型：
--
作者：
Harrington, C;Woolhandler, S;Himmelstein, DU
质量问题长期困扰着养老院行业。虽然三分之二的美国养老院是投资者所有，但很少有研究调查投资者所有对护理质量的影响。作者分析了1998年对13693家护理机构的检查数据，这些机构几乎代表了美国所有的养老院。他们将检查员发布的缺陷引用分为三类（“护理质量”、“生活质量”和“其他”），并比较了投资者拥有的、非营利的和公共的养老院的缺乏率。使用多变量模型控制病例组合、医疗补助覆盖的居民百分比、设施是否以医院为基础、是否仅为医疗保险的熟练护理设施、连锁所有权和各州的位置。该研究还评估了护士的配备情况。作者发现，投资者拥有的养老院提供的护理比非营利机构或公共养老院更差，更少。投资者拥有的设施平均每户有5.89个缺陷，比非营利设施高46.5%，比公共设施高43.0%，而且每种缺陷的数量都更多。在多变量分析中，投资者所有权预测每套住房的额外缺陷为0.679；连锁所有权预测每户家庭额外有0.633个缺陷。在投资者拥有的家庭中，护士的比例明显较低。
Quality problems have long plagued the nursing home industry. While two-thirds of U.S. nursing homes are investor-owned, few studies have examined the impact of investor-ownership on the quality of care. The authors analyzed 1998 data from inspections of 13,693 nursing facilities representing virtually all U.S. nursing homes. They grouped deficiency citations issued by inspectors into three categories ("quality of care," "quality of life," and "other") and compared deficiency rates in investor-owned, nonprofit, and public nursing homes. A multivariate model was used to control for case mix, percentage of residents covered by Medicaid, whether the facility was hospital-based, whether it was a skilled nursing facility for Medicare only, chain ownership, and location by state. The study also assessed nurse staffing. The authors found that investor-owned nursing homes provide worse care and less nursing care than nonprofit or public homes. Investor-owned facilities averaged 5.89 deficiencies per home, 46.5 percent higher than nonprofit and 43.0 percent higher than public facilities, and also had more of each category of deficiency. In the multivariate analysis, investor-ownership predicted 0.679 additional deficiencies per home; chain-ownership predicted an additional 0.633 deficiencies per home. Nurse staffing ratios were markedly lower at investor-owned homes.