Table 3.
Characteristics of studies comparing private for-profit and private not-for-profit nursing home quality of care
| Study | Place; year; data source*; No of residents or nursing homes | Factors controlled or adjusted for | |
|---|---|---|---|
| Appropriate: age, severity of illness, severity of dementia, and payment status adjustments | Inappropriate: quality measures used in other studies; measures of intensity of care | ||
| Levey et al 1973w1 | Massachusetts; 1965 and 1969; state public health department; 129 homes in each year | Payment status | None |
| Cohen and Dubay 1990w2 | United States; 1981; MMACS; 694 FP and 235 private NFP homes | Severity of illness (long term care index of function), dementia (% confused or disoriented), payment status (% of Medicare patients in facility) | None |
| Elwell 1984w3 | New York state; 1976; Residential Health Care Facilities Report (NY); 258 FP and 130 private NFP homes | Severity of illness (ADLs), dementia (proportion of residents with totally impaired alertness), payment status (proportion of days paid for by Medicaid) | None |
| Lee 1984w4 | Iowa; 1980-1; Iowa Department of Health; 254 FP and 103 private NFP homes | Unadjusted analysis | Unadjusted analysis |
| Wiesbrod and Schlesinger 1986w5 | Wisconsin; 1976; State Division of Health; 220 FP and 134 private NFP homes | Adjusted analysis but none of 4 selected appropriate factors included | None |
| Lemke and Moos 1989w6 | United States; year not listed; research nurses; 44 FP and 44 private NFP homes | Unadjusted analysis | Unadjusted analysis |
| Pearson et al 1992w7 | Australia; 1988-90; authors collected data; 120 FP and 80 private NFP homes | Severity of illness (% of high need residents) | Staffing (% of nurses who were RNs) |
| Graber 1993w8 | North Carolina; 1991; OSCAR; 167 FP and 14 private NFP homes | Unadjusted analysis | Unadjusted analysis |
| Aaronson et al 1994w9 | Pennsylvania; 1987; MMACS; 269 FP and 180 private NFP homes | Varied by analysis: staffing—severity of illness (long term care index of resident function), payment status; pressure sores—age (% aged ≥85), severity of illness (long term care index of resident function), payment status; restraint use—dementia (proportion of confused patients per 100 beds), payment status (Medicaid use rate) | Varied by analysis: staffing—none; pressure sores—restraint use; restraint use—RN to resident ratio |
| Moseley 1994w10 | Virginia; 1983-5; state medical assistance services using long-term care information system; 174 homes with 2362 FP and 787 private NFP residents | Age, severity of illness (ADLs), dementia (oriented/disoriented) | None |
| Sainfort et al 1995w11 | Wisconsin; 1982; research teams; 44 FP and 46 private NFP homes | Unadjusted analysis | Unadjusted analysis |
| Holmes 1996w12 | Michigan; 1989; MMACS; 275 FP and 60 private NFP homes | Severity of illness (ADLs), payment status (% Medicaid patient days), dementia (% of residents with cognitive deficiencies) | None |
| Johnson-Pawlson and Infeld 1996w13 | Maryland; 1991-2; OSCAR; 137 FP and 55 private NFP homes | Severity of illness (ADLs), payment status (% of residents covered by Medicare) | Staffing (RN and full time equivalent nurse positions/patient) |
| Spector and Fortinsky 1998w14 | Ohio; 1994; MDS; 843 homes | Age, dementia (cognitive performance) | None |
| Spector et al 1998w15 | United States; 1987; NMES; 1695 FP and 535 private NFP homes | Age, dementia, payment status (Medicaid coverage %) | None |
| Hughes et al 2000w16 | Continental United States; 1997; OSCAR; 10 666 FP and 3342 private NFP homes | Dementia, payment status | Staffing (in facility model), antidepressant drug use |
| Troyer 2001w17 | Florida; 1994-6; OSCAR; unclear | Payment status (private pay/Medicaid/Medicare funding) | None |
| Chou 2002w18 | United States; 1984-94; NLTCS; 1770 FP and 1044 private NFP residents | Age, severity of illness (ADLs, before admission), dementia (cognitive score on admission) | None |
| Harrington et al 2002w19 | United States; 1997-8; OSCAR; 9009 FP and 3789 private NFP homes | Severity of illness (ADLs), dementia (in secondary analysis only), payment status (% Medicaid residents) | None |
| Grabowski and Hirth 2003w20 | United States; 1995; OSCAR; 11 174 FP and 4688 private NFP homes | Severity of illness (ADLs), payment status | None |
| Berta et al 2004w21 | Ontario; 1996-2002; RCFS; not clear | Unadjusted analysis | Unadjusted analysis |
| Grabowski and Angelelli 2004w22 | United States; 1998-2000; OSCAR and MDS; 9478 FP and 3434 private NFP homes | Adjusted analysis but none of 4 selected appropriate factors included | None |
| Grabowski and Castle 2004w23 | United States; 1991-9; OSCAR; 18 432 homes, selecting those with 5 consecutive yearly assessments with upper and lower quartile scores for each quality measure | Unadjusted analysis | Unadjusted analysis |
| Grabowski 2004w24 | Continental United States; 1996; MEPS and OSCAR; 815 homes, with 1856 FP and 673 private NFP residents | Age, severity of illness (ADLs), dementia, payment status | None |
| Grabowski et al 2004w25 | United States; 1998-9; MDS and OSCAR; 15 128 homes (13 819 for daily pain information, 13 169 for pressure ulcer information, 13 859 for physical restraint information) | Adjusted analysis but none of 4 selected appropriate factors included | None |
| Konetzka et al 2004w26 | United States; 1996-2000; OSCAR; 11 968 FP and 5077 private NFP homes | Severity of illness (ADLs), dementia (% with), payment status (% private pay) | None |
| Konetzkaet al 2004w27 | United States; 1996; MEPS; 529 FP and 192 private NFP residents | Severity of illness (ADL dependence), dementia (cognitive performance), payment status (payer source) | Staffing (RNs and LPNs/100 residents, nursing assistants/100 residents |
| Lapane and Hughes 2004w28 | Ohio; 1997 and 2000; MDS; 390 FP and 109 private NFP in 1997; 391 FP and 114 private NFP homes in 2000 | Age, dementia, payment status (% of residents with Medicaid/Medicare) | None |
| Lapane and Hughes 2004w29 | IL, MA, MS, NY, OH, and SD; 2000; MDS and OSCAR; 1560 FP and 494 private NFP homes | Age, dementia (cognitive functioning), payment status (% of residents being paid for by Medicare/Medicaid) | Staffing (RN and LPN full time equivalents, and nursing assistants per 100 beds) |
| Rantz et al 2004w30 | Missouri; 2000-1; MDS and research nurses; 60 FP and 26 private NFP homes | Unadjusted analysis | Unadjusted analysis |
| Zhang and Grabowski 2004w31 | United States; 1987—MMACS, 1993—OSCAR; 5092 facilities for matched analysis between the 2 years | Severity of illness (ADL score), payment status (proportion Medicare funded) | None |
| Akinci and Krolikowski 2005w32 | Northeastern Pennsylvania; 2000-2; OSCAR; 46 FP homes and 38 private NFP homes | Unadjusted analysis | Unadjusted analysis |
| Bardenheier et al 2005w33 | United States; 1995, 1997, and 1999; NNHS; 1409 homes in 1995, 1488 in 1997, and 1423 in 1999 | Age, payment status (payment source) | None |
| Zinn et al 2005w34 | United States; 2002-3; MDS; 10 763 FP, 4802 private NFP, 994 public | Adjusted analysis but none of 4 selected appropriate factors included | None |
ADLs=activities of daily living; LPN=licensed practical nurse; FP=for-profit; NFP=not-for-profit; RN=registered nurse.
*MDS (minimum data set): quarterly survey of residents in US Medicaid certified facilities (resident level quality assessed); MMACS (Medicare and Medicaid Automated Certification System)/OSCAR (Online Survey, Certification and Reporting): facility level survey completed every 9-15 months for US Medicare/Medicaid certification (OSCAR replaced MMACS in 1991); MEPS (Medical Expenditure Panel Survey): see NMES; NMES (National (US) Medical Expenditure Survey): survey of nationally representative sample of people in nursing and personal care homes and facilities for mentally challenged people (collects information on health expenditures); NLTCS (National (US) Long Term Care Survey): survey of nationally representative sample of elderly, disabled, Medicaid beneficiaries in community or institutional settings (tracks expenditures, family caregiving, and Medicaid service use); NNHS (National (US) Nursing Home Survey): survey of nationwide sample of nursing homes conducted by the National Center for Health Statistics (includes non-Medicare/Medicaid facilities; tracks service use and costs); OSCAR: see MMACS; RCFS (Residential Care Facilities Survey): Statistics Canada census of residential care facilities.