Health Consequences of Corporate Changes in the Nursing Home Industry

随着许多州经历财政危机和医疗补助预算的缩减，可用于长期护理的公共资源的限制可能需要更多地依赖私人资本投资来更新老化的养老院基础设施。然而，一些研究表明，公司所有权对设施中的个人居民的健康结果产生了负面影响，公司连锁店的收购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，这些关切是基于经验研究，这些研究没有考虑到公司链可能收购经营不善的设施，也没有考虑到在收购后立即改变设施的结果可能很困难。因此，我们建议研究的重要性，收购和剥离的变化，为设施和居民的成果，并制定一个更准确的措施，在个别链的成员，这将使我们能够区分链，不同的规模和质量的居民的成果。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的变化，重点关注单个连锁店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店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，专科护理提供和行业标准的实现。我们还将确定最近连锁店所有权的变化对居民护理结果的影响（包括临终护理，康复住院和长期熟练护理住院期间的相关结果），控制连锁店和设施中居民人口的变化。最后，我们将评估连锁店是否在其养老院成员中对其产品进行标准化，以观察成员运营和绩效随时间的变化，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因链类型而异（例如，国家、地区或单一国家）以及这些变化如何随着收购或剥离后的时间长度而发展。为了研究这些问题，我们将结合联合收割机现有的医疗保险索赔和MDS数据在居民一级，OSCAR数据的所有护理设施和国家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.