Table 3. Determinants coded to the outer setting domain.

Construct	Determinant
Needs & Resources of Those Served by the Organization	No studies
Cosmopolitanism	No studies
Peer pressure	Higher competition [13, 16, 46–63] Higher excess bed capacity in county [16, 64] Higher service demand [62] Nursing homes per population [64] Proportion of chains in region [55, 65, 66] Proportion of for-profit facilities [66] Proportion of hospital-based facilities [55, 66] Transparency (publication of star-rating) [53]
External Policy & Incentives	Higher state focus on infection prevention [67] Minimum staffing standard [68–70] More stringent nursing home administrator licensing criteria Ombudsman available [71–73] State-level mandatory overtime laws [46] States with certificate of need law [74]
Other	Ageing advocacy group influence [66] Democratic party controlled legislature (USA) [66] Governor’s institutional power [66] Higher local income [47, 50, 52, 59, 60, 62, 63, 66] Higher local unemployment [75] Higher mean age of service users [51, 66, 76] Higher population density [36, 46, 51, 62, 76–87] Higher proportion of African-American service users [13, 52, 76, 88, 89] Higher proportion of African-Americans residents in county [52] Higher proportion of Asian service users [52] Higher proportion of female service users [45, 51] Higher proportion of George W. Bush supporters in county [74] Higher proportion of Hispanic service users [13, 52, 89] Higher proportion of Hispanic residents in county [52] Higher proportion of married service users [45] Higher proportion of other non-White service users [13] Higher proportion of service users with dementia [14, 47, 49, 50, 54, 58, 59, 62, 63, 90–92] Higher proportion of service users with a disability [16, 45, 82] Higher proportion of service users with intellectual disability [49, 50, 54, 58, 59, 63, 92] Higher proportion of service users with incontinence needs [14, 54, 82, 90, 91, 93–97] Higher proportion of service users with mental illness [14, 47, 49, 50, 54, 57–59, 62, 63, 82, 90, 92–96, 98–102] Higher proportion of service users with obstructive bowel syndrome [82] Higher proportion of service users with high/complex care needs [14, 16, 46, 47, 49–52, 54, 58–64, 72, 82, 86, 90–97, 99, 103–110] Higher proportion of veterans [111] Higher proportion of White residents [51, 76, 112] Higher public funding [47–50, 55, 57–60, 63–66] Higher rate of religiosity [74] Individualistic state [74] Higher legislative professionalism [66] Nursing home industry influence [66] Moralistic state [66] State with Democratic Governor (USA) [55, 66]