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）：护理质量提供给居住在疗养院体弱的老人仍然是一个重要的和令人困惑的问题，在美国的卫生政策。鉴于非营利组织享有的税收优惠待遇，政策制定者和研究人员都很有兴趣研究非营利部门是否比营利部门提供更高的质量。大量的文献研究了这个问题，但绝大多数现有的研究都采取了横截面的方法来比较营利性和非营利组织的质量。然而，选择非营利设施的消费者类型可能在许多未观察到的方面与选择营利设施的消费者完全不同。如果是这样的话，简单地比较营利性组织和非营利组织的质量，控制可观察到的特征，可能会产生误导性的估计。通过使用“差异距离”最近的非营利性养老院相对于最近的营利性养老院，我们可以模拟随机化的居民到更多或更少的“暴露”到非营利性家庭时，估计所有权的护理质量的影响。基于这种方法，提出了以下具体目标：目标1：使用一系列患者特征，包括付款人类型，敏锐度，人口统计学（种族，性别和年龄）和社会经济地位（教育;邮政编码水平收入），检查营利性和非营利性养老院的选择和访问差异。目标二：测试距离最近的非营利性养老院相对于最近的营利性养老院的差异对进入非营利性养老院的可能性的影响。计划的子分析包括在城市/农村市场的背景下检查距离和所有权选择的作用，从亚急性疗养院单位的医院出院，以及疗养院患者的不同亚组（例如，是否有证据表明少数民族或医疗补助接受者之间的关系较弱，如果这些居民更有可能不得不绕过最近的设施以获得护理，情况可能就是这样）。目标3：使用工具变量分析来检查所有权对经风险调整的个人水平短期住院质量指标（如日常生活活动下降或30天再住院）和经风险调整的个人水平长期住院质量指标（如压疮或身体限制）的影响。重要性：通过研究养老院所有权和护理质量之间的联系，这项研究为数百万在养老院接受护理的美国人提供了一个提高护理质量的机会。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，这种差异解释了所有权类型之间未观察到的患者差异，并且也可以应用于研究其他设施特征的影响，例如连锁所有权。因此，从这项研究中获得的信息有可能作出重要的研究和政策相关的贡献，旨在提高所有养老院居民的护理质量。公共卫生关系：政策制定者和研究人员都很有兴趣研究非营利性养老院是否比营利性养老院提供更高的质量。通过使用一种新的实证策略来研究这种关系，本研究为数百万在养老院接受护理的美国人提供了一个提高护理质量的机会。