Nursing Homes Quality and Variations in State Regulations

描述（由申请人提供）：养老院的质量和国家法规的变化养老院的护理质量多年来一直受到关注，尽管最近医疗保险和医疗补助服务中心（CMS）实施了改革——改革监管过程和在网上发布养老院质量报告卡。该项目的目标是通过研究国家法规各方面（“国家调查”过程和民事罚款）与质量的几个维度之间的关系，为影响养老院护理质量的因素提供知识库。具体目的是检验以下假设：国家监管过程的紧迫性与1)通过风险调整后的健康结果衡量的临床质量有关；2)人员配置；3)酒店服务质量。本研究将填补现有文献中关于高质量养老院护理决定因素的空白。该研究将结合从州许可证办公室调查获得的数据，最小数据集（MDS），医疗保险分母文件以及其他几个来源，包括美国人口普查，劳工统计局和总问责局（GAO）。统计回归技术将用于检验假设，即国家调查和执法过程的具体方面与护理质量有关。工具变量技术将用于解决质量和质量监管的潜在内生性问题。这项研究对公共卫生的影响源于它所提供的信息和知识的作用。这项研究将为州和联邦政策改革提供信息，这些政策旨在促进养老院的高质量护理，为美国人口中最脆弱的群体之一提供护理。

DESCRIPTION (provided by applicant): Nursing homes' quality and variations in state regulations Quality of care in nursing homes has been of concern for many years and continues to be of concern despite recent reforms implemented by the Centers for Medicare & Medicaid Services (CMS) - reforms of the regulatory oversight process and the publication of nursing home quality report cards on the web. The objective of this project is to contribute to the knowledge base regarding factors influencing quality of nursing home care by examining the relationships between aspects of state regulations (the "state survey" process and civil monetary penalties) and several dimensions of quality. The specific aims are to test the hypotheses that the stirngency of the state regulatory process is associated with 1) clinical quality measured by risk- adjusted health outcomes; 2) staffing ; and 3) quality of hotel services. This study will bridge a gap in the extant literature on the determinants of high quality nursing home care. The study will combine data obtained from a survey of state licensure offices, the Minimum Data Set (MDS), the Medicare Denominator file, and several other sources including the U.S. Census, the Bureau of Labor Statistics, and the General Accountability Office (GAO). Statistical regression techniques will be used to test the hypotheses that specific aspects of the state survey and enforcement process are associated with quality of care. Instrumental variable techniques will be used to address the potential endogeneity of quality and quality regulation. The public health implications of this study derive from the role of the information and knowledge developed by it. This study will inform state and federal policy reform efforts targeted at regulation and enforcement policies designed to promote high quality of care in nursing homes, which provide care to one of the most vulnerable segments of the U.S. population.