Spector, William

Authors: Spector W., Mukamel D.
Title: Nursing home administrators' perceptions of competition and strategic responses.
Publication: Long Term Care Interface 2(3):37-41.
Date: March 2001
Abstract: This paper presents findings from a 1999 mailed survey of nursing home administrators in New York State, designed to elicit their perceptions of competition in the nursing home market and their strategic plans to cope with changing market conditions. Results show that administrators think that nursing home markets have become more competitive and expect this trend to continue. They perceive differences in the way individual customers choose nursing homes versus the way MCOs and hospitals make such choices. They believe that individual consumers place a higher value on quality of life factors, while aggregate purchasers rate price and the availability of complex sub-acute services higher. Strategic responses by nursing homes varied by ownership type.
Topics: Cost, Medicaid, Medicare, Organizational Research.

Authors: Mukamel DB, Spector WD.
Title: Nursing home costs and risk-adjusted outcome measures of quality.
Publication: Med Care 38(1):78-89.
Date: 2000
Abstract: The inadequacy of quality of care in nursing homes has been and continues to be a focus of public concerns. Understanding the relationship between quality and costs can offer guidance to policies designed to encourage high quality. The study's objectives were to investigate the relationship between costs and quality of care in nursing homes, and to test the hypothesis that higher quality may be associated with lower costs. Statistical regression techniques were used to estimate nursing home variable-cost functions that included three risk-adjusted outcome measures of quality. Quality measures were based on decline in functional status, worsening pressure ulcers, and mortality. The study hypothesis was tested by an F test for the exclusion of nonlinear quality variables in the cost functions. The study included 525 free-standing private and public nursing homes in New York State, or 84 percent of all nursing homes in the state during 1991. F tests rejected the hypotheses that the three quality measures could be excluded from the cost function and that the association between costs and quality was linear. An inverted U-shape relationship between quality and costs suggests that there are quality regimens in which higher quality is associated with lower costs. Policies that encourage research to identify care protocols and management strategies leading to better outcomes and lower costs, as well as policies that encourage dissemination of such practices, may prevent decline in quality despite the continued financial constraints faced by nursing homes.
Topics: Cost, Long-term Care.
Availability: AHRQ Publication No. 00-R019 is available from the AHRQ Publications Clearinghouse.

Authors: Spector W, Fleishman J.
Title: Combining activities of daily living (ADL) with instrumental activities of daily living (IADL) to measure functional disability.
Publication: Journal of Gerontology: Social Sciences 53B(1):S46-S57.
Date: 1998
Abstract: This article presents psychometric justification for a combined Activities of Daily Living/Instrumental Activities of Daily Living scale based on item response theory methods. Analyses show that a simple sum of item responses can be used to derive a measure of functional disability.
Topics: Methods.
Availability: AHCPR Publication No. 98-R028 is available from the AHRQ Publications Clearinghouse.

Authors: Spector W, Fortinsky R.
Title: Pressure ulcer prevalence in Ohio nursing homes: Clinical and facility correlates.
Publication: Journal of Aging and Health 10(1):62-80.
Date: 1998
Abstract: This article examines pressure sore risk factors in a large sample of nursing home residents in Ohio in 1994. The study finds that many nursing home residents remain at great risk of developing pressure sores. After controlling for clinical factors, residents in rural facilities were less likely to have a pressure sore.
Topics: Long-term Care, Prevention.
Availability: AHCPR Publication No. 98-R027 is available from the AHRQ Publications Clearinghouse.

Authors: Spector W, Mukamel D.
Title: Using outcomes to make inferences about nursing home quality.
Publication: Evaluation of the Health Professions 21(3):291-315.
Date: 1998
Abstract: Recent concerns about containing the growth of public expenditures on nursing home care and the development of prospective and case-mix reimbursement systems with incentives for cost containment have increased the importance of monitoring quality in nursing homes. The current view is that quality assurance systems should include more outcome measures to improve quality. This article discusses why it is difficult to develop facility-level outcome measures that can be used to evaluate and compare the quality of care of nursing homes. The article places the current interest in outcomes measures in its historical policy context and reviews important conceptual and methodological issues associated with outcome-based quality assessment. The authors discuss the difficulty in isolating the facility effect when studying nursing home outcomes and implications of using different estimation approaches. In conclusion, they discuss the need to integrate research with outcome-based quality assurance systems to allow ongoing evaluation and quality improvement.
Topics: Long-term Care, Methods.
Availability: AHCPR Publication No. 98-R083 is available from the AHRQ Publications Clearinghouse.

Authors: Spector W, Selden T, Cohen J.
Title: Impact of ownership type on nursing home outcomes.
Publication: Health Economics 7:639-53.
Date: 1998
Abstract: This article examines the sorting of residents between for-profit and nonprofit nursing homes and the health outcomes of residents conditional on ownership type. Results suggest that nonprofit facilities are more likely to attract residents who have the highest cost of monitoring quality, place the greatest weight on quality, and face the fewest constraints in their choice of home. Outcome results suggest that ownership type can affect quality of care for at least some residents.
Topics: Long-term Care.

Authors: Binstock R, Spector W.
Title: Five priority areas for research on long term care.
Publication: Health Services Research 32(5):715-30.
Date: 1997
Abstract: This article presents five priority areas for research in long-term care given the context of rapidly shifting health care market forces and political pressures to contain Medicare and Medicaid expenditures. Areas recommended include quality of care measures, the linkage of costs and quality of care, appropriateness of care in the many types of long-term care settings that have emerged in recent years, evaluation of innovations in care provision with respect to impact on cost and quality, and research on the evolution of managed care and its effects on long-term care provision.
Topics: Cost, Long-term Care, Research Agenda.
Availability: AHCPR Publication No. 98-R020 is available from the AHRQ Publications Clearinghouse.

Authors: Jackson M, Spector W, Rabins P.
Title: Risk of behavior problems among nursing home residents in the United States.
Publication: Journal of Aging and Health 9(4):451-72.
Date: 1997
Abstract: This article represents the first report of risk factors associated with behavior problems in nursing homes in a nationally representative sample using multivariate techniques. The findings show, not surprisingly, that cognitive impairment is a major risk factor, but also show the importance of ADLs, incontinence, mobility and psychoses. Estimates are made separately for all behaviors, aggressive behaviors, collecting behaviors, wandering, and delusions and hallucinations.
Topics: Long-term Care, Mental Health, Prevention.
Availability: AHCPR Publication No. 98-R011 is available from the AHRQ Publications Clearinghouse.

Author: Spector W.
Title: Measuring functioning in daily activities for persons with dementia.
Publication: Alzheimer Disease and Associated Disorders 11(Suppl):81-90.
Date: 1997
Abstract: This article evaluates the state of art of measuring functional disability with IADL and ADL scales for persons with dementia. Generic and dementia specific scales are compared. Among dementia specific scales, performance measures and proxy-respondent approaches are discussed. Recommendations are made for future research.
Topics: Mental Health, Methods, Research Agenda.
Availability: AHCPR Publication No. 98-R025 is available from the AHRQ Publications Clearinghouse.

Authors: Spector W, Gage B.
Title: AHCPR research on long-term care.
Publication: Rockville (MD): AHCPR.
Date: 1997
Abstract: This program note highlights research findings of long-term care research conducted and funded by AHRQ since 1990 and provides a complete list of such research. The program note is organized into six broad themes: use, cost, and financing; access and quality of care; organization and delivery of care; consumer and caregiver behavior; special populations; and data development and methodology.
Topics: Long-term Care.
Availability: AHCPR Publication No. 97-0054 is available from the AHRQ Publications Clearinghouse.

Author: Spector W.
Title: Functional disability scales.
Publication: In Quality of Life and Pharmacoeconomics in Clinical Trials, edited by Spilker B. New York (NY): Lippincott-Raven Publisher.
Date: 1996
Abstract: This article reviews the major generic measures of functional disability including ADLs and IADLs used for adults. The scales are described, purpose and use are discussed, and the scales are evaluated in terms of the psychometric properties of the scale, evidence of reliability and validity, sensitivity to setting, and responsiveness to medical treatments. Approaches to combining ADL and IADL items are discussed.
Topics: Mental Health, Methods.
Availability: AHRQ Publication No. 96-R053 is available from the AHRQ Publications Clearinghouse.

Author: Spector W, Cohen J.
Title: The effect of Medicaid reimbursement on quality of care in nursing homes.
Publication: Journal of Health Economics 1996;15:23-48.
Date: 1996
Abstract: This study uses a nationally representative sample of nursing homes and nursing home residents to examine the effect of Medicaid reimbursement on quality of care. The analysis shows that both reimbursement approach and level affect nursing home quality, as measured by case-mix adjusted staff to resident ratios. The analysis also shows that staffing ratios have an impact on resident outcomes, and these impacts vary by professional category of staff.
Topics: Cost, Long-term Care, Medicaid.
Availability: AHCPR Publication No. 96-R116 is available from the AHRQ Publications Clearinghouse.

Author: Spector W, Reschovsky J, Cohen J.
Title: Appropriate placement of nursing home residents in lower levels of care.
Publication: Milbank Quarterly 1996;74(1):139-60.
Date: 1996
Abstract: This article discusses why clinically inappropriate residents in nursing homes continue to be placed there, updates and improves estimates of the number of persons who based on clinical criteria may be place in lower levels of care, discusses other factors that should enter into estimates of appropriate placement, and the reasons why potential savings that these estimates suggest may be difficult to achieve.
Topics: Long-term Care, Prevention.
Availability: AHCPR Publication No. 96-R067 is available from the AHRQ Publications Clearinghouse.

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