Author: Mukamel DB, Spector WD.
Title: Nursing home costs and risk-adjusted outcome measures of quality.
Publication: Med Care 38(1):78-89.
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.
Availability: AHRQ Publication No. 00-R019 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.
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.
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 1998;21(3):291-315.
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.
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.
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.
Authors: Binstock R, Spector W.
Title: Five priority areas for research
on long term care.
Publication: Health Services Research 32(5):715-30.
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.
Availability: AHCPR Publication No. 98-R020 is available from the AHRQ
Author: Fraser I.
Title: Research on health care organizations and markets—The
best and worst of times.
Publication: Health Services Research 32(5):669-78.
This article contains reflections from four short papers commissioned
by AHCPR in January 1997 to identify central managed care research questions
in the areas of health care markets, access, chronic illness, and long
Availability: AHCPR Publication No. 98-R019 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.
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.
Availability: AHCPR Publication No. 98-R011 is available from the AHRQ Publications Clearinghouse.
Authors: Spector W, Gage B.
Title: AHCPR research on long-term care.
Publication: Rockville (MD): AHCPR.
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.
Availability: AHCPR Publication No. 97-0054 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.
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.
Availability: AHCPR Publication No. 96-R116 is available from
the AHRQ Publications Clearinghouse.
Authors: 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.
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.
Availability: AHCPR Publication No. 96-R067 is available
from the AHRQ Publications Clearinghouse.
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