Health Consequences of Corporate Changes in the Nursing Home Industry

描述（由申请人提供）：随着许多州经历财政危机和医疗补助预算的缩减，用于长期护理的公共资源受到限制，可能需要更多地依赖私人资本投资来更新老年养老院的基础设施。然而，一些研究表明，企业所有权对设施中个人居民的健康结果产生负面影响，连锁企业收购的增加引起了人们对健康结果可能受到影响的担忧。与此同时，这些担忧是基于实证研究，没有考虑到连锁企业可能收购经营不善的设施，或者在收购后立即改变设施的结果可能很困难。因此，我们建议检查收购和剥离变化对设施和居民结果的重要性，并制定更准确的单个连锁店成员资格衡量标准，这将使我们能够区分在规模和质量结果上对居民不同的连锁店。我们的第一个目标是描述从2000年到2010年养老院行业连锁所有权构成的变化，重点关注单个连锁的规模和服务组合复杂性的变化，并研究国家政策和市场环境对连锁收购或剥离设施的可能性的影响。然后，我们将确定最近连锁所有权的变化对设施运营和护理流程的影响，如入院模式、人员配备、入住率、专业护理提供和实现行业标准。我们还将确定连锁医院所有权的近期变化对居民护理结果的影响（包括临终关怀、康复住院和长期熟练护理住院期间的相关结果），控制连锁医院和设施中居民人口的变化。最后，我们将评估连锁机构是否根据成员运营和绩效随时间的变化对其养老院成员的产品进行标准化，以及标准化是否因市场投入和监管条件而异。在每个目标中，我们将确定结果如何随链类型（例如，国家，地区或单一州）而变化，以及变化如何作为收购或剥离后时间长度的函数发展。为了研究这些问题，我们将结合现有的居民医疗保险索赔和MDS数据，所有护理机构的OSCAR数据以及州一级的市场和政策数据集。

DESCRIPTION (provided by applicant): With many states experiencing fiscal crises and shrinking Medicaid budgets, constraints on the public resources available for long-term care may require a greater reliance on private capital investments to update the aging nursing home infrastructure. However, some studies have shown negative effects of corporate ownership on health outcomes for individual residents in facilities and increased acquisitions by corporate chains raises concerns that health outcomes may suffer. At the same time, these concerns are based on empirical studies that did not consider that corporate chains may acquire poorly operating facilities or that changing facility outcomes may be difficult immediately following acquisitions. Hence, we propose to examine the importance of the acquisition and divestiture changes for both facility and resident outcomes and to develop a more accurate measure of membership within individual chains which would allow us to distinguish chains that differ both in size and quality outcomes for residents. Our first aim is to describe the changing composition of chain ownership in the nursing home sector from 2000 through 2010, focusing on changes in the size and service mix complexity of individual chains and examining the impact of state policies and market environment on the likelihood of chains acquiring or divesting facilities. We will then determine the impact of recent changes in chain ownership on facility operations and care processes such as admission patterns, staffing, occupancy rates, specialty care provision, and achievement of industry standards. We will also determine the impact of recent changes in chain ownership on residents' care outcomes (including outcomes relevant during end of life care, rehabilitation stays and long-term skilled nursing stays), controlling for changes in residen populations across chains and facilities. Finally, we will evaluate whether chains standardize their product across their nursing home members as observed in changes in members' operations and performance over time and whether standardization varies by market inputs and regulatory conditions. Within each aim, we will determine how the results vary by type of chain (e.g., national, regional or single-state) and how the changes develop as a function of length of time since acquisition or divestiture. In order to study these issues, we will combine existing Medicare claims and MDS data at the resident level, OSCAR data on all nursing facilities and state level market and policy data sets.