Selection and the Quality Impact of Nursing Home Ownership

疗养院所有权的选择和质量影响

• 批准号: 7697047
• 负责人: DAVID C GRABOWSKI
• 金额: $ 29.33万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-15 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7697047
• 关键词: Accounting; Activities of Daily Living; Acute; Age; American; Bypass; Caring; Characteristics; Code; Data Set; Decubitus ulcer; Education; Exposure to; Frail Elderly; Gender; Health Policy; Health Services Accessibility; Healthcare; Home Nursing Care; Home environment; Hospitalization; Hospitals; Income; Lead; Link; Literature; Long-Term Care; Marketing; Measures; Medicaid; Medicare claim; Methodology; Minority; Nursing Homes; Ownership; Patients; Persons; Physical Restraint; Policy Research; Population Study; Provider; Quality of Care; Race; Randomized; Relative (related person); Religion and Spirituality; Research Personnel; Risk; Role; Rural; Scientist; Signal Transduction; Socioeconomic Status; Subgroup; Taxes; Testing; base; cost; demographics; improved; instrument; interest; novel; novel strategies; prospective; public health relevance; social

DESCRIPTION (provided by applicant): The quality of care delivered to frail elders residing in nursing homes remains an important and perplexing issue in American health policy. Given the preferential tax treatment afforded nonprofit firms, there has been much interest among policymakers and researchers alike in examining whether the nonprofit sector provides higher quality relative to its for-profit counterpart. A large literature examines this issue, but the vast majority of the existing studies have taken a cross-sectional approach to compare for-profit and nonprofit quality. However, the type of consumer who chooses a nonprofit facility may be quite different in many unobserved ways from the consumer who selects a for-profit facility. If so, simple comparisons of quality in for-profits and nonprofits, controlling for observable characteristics, may yield misleading estimates. By using "differential distance" to the nearest nonprofit nursing home relative to the nearest for-profit nursing home, we can mimic randomization of residents into more or less "exposure" to nonprofit homes when estimating the effects of ownership on quality of care. Based on this methodology, the following specific aims are proposed: Aim 1: To examine selection and access differences across for-profit and nonprofit nursing homes using a range of patient characteristics, including payer type, acuity, demographics (race, gender and age), and socio- economic status (education; zip code level income). Aim 2: To test the effect of differential distance to the nearest nonprofit nursing home relative to the nearest for-profit nursing home on likelihood of entry into a nonprofit nursing home. Planned sub-analyses include an examination of the role of distance and ownership choice in the context of urban/rural markets, discharges from hospitals with a sub-acute nursing home unit, and different subgroups of nursing home patients (e.g., is there evidence of a weaker relationship among racial minorities or Medicaid recipients, which may be the case if those residents are more likely to have to bypass the nearest facility in order to gain access to care). Aim 3: To use instrumental variables analysis to examine the effect of ownership on risk-adjusted, person-level short-stay measures of quality such as activities of daily living decline or 30-day re-hospitalization and risk- adjusted, person-level long-stay measures of quality such as pressure ulcers or physical restraints. Significance: By examining the link between nursing home ownership and quality of care, this study provides an opportunity to improve the quality of care for the millions of Americans receiving care in nursing homes. This study will also provide long-term care researchers with a potential new approach to analyzing for-profit and nonprofit differences which accounts for unobserved patient differences across ownership types, and which could also be applied to study the impact of other facility characteristics such as chain ownership. Thus, the information derived from this study has the potential to make important research and policy-relevant contributions aimed at improving the quality of care for all nursing home residents. PUBLIC HEALTH RELEVANCE: There has been much interest among policymakers and researchers alike in examining whether nonprofit nursing homes provide higher quality relative to their for-profit counterparts. By examining this relationship using a novel empirical strategy, this study provides an opportunity to improve the quality of care for the millions of Americans receiving care in the nursing home setting.

描述（由申请人提供）：在疗养院中，居住在养老院中的脆弱长者的护理质量仍然是美国卫生政策中的一个重要而令人困惑的问题。鉴于优先税收待遇提供了非营利性公司，决策者和研究人员都在研究非营利部门是否提供了相对于其营利性同行提供的质量更高的兴趣。大型文献研究了这个问题，但是绝大多数现有研究都采用了横断面的方法来比较营利性和非营利性质量。但是，选择非营利设施的消费者类型在许多未观察的方式上可能与选择营利性设施的消费者有很大不同。如果是这样，可以根据可观察到的特征来控制营利性和非营利组织中的质量简单比较，可能会产生误导性的估计。通过使用与最近的营利性疗养院相对于最近的非营利疗养院的“微分距离”，我们可以在估计所有权对护理质量的影响时，将居民随机化或多或少地“接触”非营利性房屋。基于这种方法，提出了以下具体目的：目标1：使用一系列患者特征，包括付款人类型，敏锐性，人口统计学（种族，性别和年龄）以及社会经济状况（教育代码； ZIP代码水平），使用一系列患者特征检查和访问跨营利和非营利性疗养院的选择差异。目标2：测试与最近的非营利性疗养院与最近的营利性疗养院的差异距离，可能会进入非营利性疗养院。计划中的子分析包括检查城市/农村市场中距离和所有权选择的作用，拥有亚急性疗养院单位的医院的出院以及疗养院患者的不同亚组（例如，是否有证据表明，如果居民可以使用居民，则可能会在居民中获得较差的少数群体之间的关系较弱，而居民可以通过秩序获得秩序，而这可能是居住的机能，而居民可以通过秩序访问该机构。目的3：使用工具变量分析来检查所有权对风险调整后的人级短期质量衡量标准，例如日常生活衰落的活动或30天的重新住院活动以及风险调整后的，人级的长期长期质量的长期测量，例如压力溃疡或物理约束。意义：通过检查疗养院所有权与护理质量之间的联系，这项研究提供了一个机会，以改善数百万美国人在疗养院接受护理的美国人的护理质量。这项研究还将为长期护理研究人员提供一种潜在的新方法来分析营利性和非营利性差异，这些差异解释了所有权类型之间未观察到的患者差异，并且还可以应用于研究其他设施特征（例如连锁所有权）的影响。因此，从这项研究中得出的信息有可能做出重要的研究和与政策相关的贡献，旨在提高所有疗养院居民的护理质量。公共卫生相关性：政策制定者和研究人员都在研究非营利性疗养院是否提供更高质量相对于其营利性同行，人们引起了人们的极大兴趣。通过使用一种新颖的经验策略来检查这种关系，这项研究提供了一个机会，可以改善在疗养院中接受护理的数百万美国人的护理质量。