Performance of High Medicaid Nursing Homes-Contextual and Management Factors

描述（由申请人提供）：鉴于美国人口老龄化和日益多样化，老年人和残疾人公平获得高质量的养老院护理是一个重要的公共政策问题。养老院护理被描述为一个双层系统，较低的一层由设施组成，主要是医疗补助居民。这些设施可能有较高比例的少数民族，报告质量较低，并且在资源有限的环境中运营，因为他们的付款人组合主要是医疗补助，报销率低于医疗保险和私人支付。然而，我们观察到这些资源受限的设施在质量和财务绩效方面的表现存在差异。该研究将集中于结构、市场和管理因素在解释医疗补助人口普查（>85%）较高的养老院的质量和财务绩效差异中的作用。采用混合方法，本研究将探讨以下研究目标：1)研究与高医疗补助人口普查养老院高绩效相关的结构和市场因素。2)研究管理因素（领导风格、战略导向、人力资源管理实践和知识管理）与高医疗补助人口普查养老院的高绩效之间的关系。3)研究护理人员离职是否在养老院管理因素（领导风格和人力资源管理实践）与绩效之间起中介作用。4)从护理人员和养老院管理的角度探讨具体目标1-3中测试的因素如何以及为什么会影响高绩效。我们的研究是创新的，因为它将是第一个混合方法研究，探索可能解释高医疗补助普查设施之间表现差异的背景因素。本研究将采用混合方法，顺序解释设计，包括两个不同的阶段，定量后定性。定量分析将使用二手数据和调查数据。调查的分析样本将包括来自大约1000家拥有高医疗补助普查的养老院的管理人员，定性样本将包括对护理人员的访谈

DESCRIPTION (provided by applicant): Equitable access to high quality nursing home care for older and disabled populations is an important public policy issue given the aging and increasingly diverse U.S. population. Nursing home care has been described as a two-tiered system with the lower tier consisting of facilities housing predominantly Medicaid residents. These facilities are likely to have a higher proportion of minorities, and report lower quality car and operate in a resource constrained environment as their payer mix is predominantly Medicaid with lower reimbursement rates than Medicare and private pay. However, we observe performance variations across these resource-constrained facilities in both quality and financial performance. The proposed study will focus on the role of structural, market, and management factors in explaining quality and financial performance variations among nursing homes with high Medicaid census (>85%). Using a mixed methods approach, our study will address the following research aims: 1) Examine the structural and market factors associated with high performance among nursing homes with high Medicaid census. 2) Examine the association of management factors (leadership style, strategic orientation, HRM practices, and knowledge management) with high performance among nursing homes with high Medicaid census. 3) Examine whether nursing staff turnover mediates the relationship between management factors (leadership style and HRM practices) and performance among these nursing homes. 4) Explore how and why the factors tested in Specific Aims 1-3 may influence high performance from the perspectives of nursing staff and nursing home management. Our study is innovative in that it will be the first mixed methods study to explore contextual factors that may explain performance differences among facilities with high Medicaid census. This study will use a mixed methods, sequential explanatory design, consisting of two distinct phases, quantitative followed by qualitative. The quantitative analysis will use secondary data as well as survey data. The analytic sample for the survey will consist of managers from approximately 1000 nursing homes with high Medicaid census, and the qualitative sample will consist of interviews with nursing staff (6) and managers (2) from eight nursing homes (high and low performance) for a total of 64 interviews in 4 states (California, Georgia, New York, and Texas). The study findings will allow policymakers and nursing home managers to better understand the structural, market, and management factors associated with better performance in resource-constrained nursing facilities. We believe that the findings of our study and their dissemination will provide an impetus for developing interventions to improve the performance of these facilities in terms of lower costs and better quality. This may, in turn, reduce health care disparities for low income, minority, elderly, and disabled residents in these facilities, which are among AHRQ's priority populations.