Table 3.
Association between Nursing Home Clinician Specialization and Regional Performance on Nursing Home Quality Measures
| Quality Measures | ||||||
|---|---|---|---|---|---|---|
| HRR-level Variables | Use of anti-psychotic medications (long-term) | Use of anti-psychotic medications (short-term) | Use of restraints | Use of indwelling urinary catheters | Residents with a urinary tract infection | Residents with symptoms of depression |
| NH specialists per 1,000 beds | −0.061 (−0.136 to 0.014) | −0.017* (−0.033 to −0.001) | 0.004 (−0.014 to 0.022) | −0.018* (−0.034 to −0.001) | −0.022 (−0.049 to 0.005) | 0.114* (0.028 to 0.200) |
| Percent of NHs part of chain | 0.007 (−0.004 to 0.019) | −0.002 (−0.004 to 0.003) | −0.006* (−0.009 to −0.003) | −0.004* (−0.007 to −0.002) | 0.002 (−0.185 to 0.666) | −0.030* (−0.043 to −0.017) |
| Percent of NHs that are for-profit | 0.002 (−0.011 to 0.016) | 0.000 (−0.003 to 0.003) | −0.000 (−0.003 to 0.003) | 0.008* (0.005 to 0.011) | 0.001 (−0.005 to 0.005) | −0.040* (−0.056 to −0.024) |
| Percent of stays covered by Medicaid | −0.023 (−0.057 to 0.010) | −0.001 (−0.008 to 0.006) | 0.022* (0.014 to 0.030) | −0.034* (−0.041 to −0.027) | −0.034* (−0.046 to −0.022) | −0.041* (−0.079 to −0.003) |
| Percent of stays covered by Medicare | −0.062* (−0.119 to −0.005) | 0.010 (−0.001 to 0.022) | 0.014 (0.000 to 0.028) | −0.023* (−0.035 to −0.010) | −0.017 (−0.038 to 0.004) | 0.018 (−0.048 to 0.083) |
| Average patient age in years | −0.717* (−0.827 to −0.606) | −0.053* (−0.076 to −0.030) | −0.039* (−0.065 to −0.012) | −0.042* (−0.067 to −0.018) | −0.063* (−0.104 to −0.023) | −0.651* (−0.779 to −0.523) |
| Percent of patients who are white | 0.062* (0.042 to 0.082) | −0.002 (−0.006 to 0.002) | 0.006* (0.001 to 0.011) | 0.014* (0.010 to 0.019) | 0.027* (0.020 to 0.034) | 0.059* (0.036 to 0.082) |
| Percent of patients who are female | −0.091* (−0.169 to −0.012) | 0.010 (−0.007 to 0.026) | 0.041* (0.022 to 0.060) | −0.010 (−0.028 to 0.007) | 0.084* (0.055 to 0.113) | −0.083 (−0.174 to 0.008) |
| RN to total staffing ratio | −0.081* (−0.098 to −0.065) | −0.020* (−0.024 to −0.017) | −0.008* (−0.012 to −0.004) | 0.003 (−0.000 to 0.007) | −0.018* (−0.024 to −0.012) | 0.083* (0.064 to 0.102) |
| Direct care staff hours per patient day | −3.477* (−4.115 to −2.839) | −0.737* (−0.870 to −0.604) | 0.206* (0.052 to 0.359) | 0.016 (−0.125 to 0.158) | −0.302* (−0.535 to −0.069) | −4.861* (−5.595 to −4.127) |
| Percent of NHs with APPs (e.g., NPs) | 0.015* (0.003 to 0.027) | 0.005* (0.002 to 0.007) | 0.002 (−0.001 to 0.005) | −0.008* (−0.011 to −0.005) | 0.004 (−0.001 to 0.008) | 0.005 (−0.008 to 0.019) |
| Average patient acuity index | −0.465* (−0.908 to −0.023) | 0.096* (0.003 to 0.188) | 0.248* (0.141 to 0.354) | 0.016 (−0.083 to 0.011) | 0.437* (0.275 to 0.599) | −0.124 (−0.633 to 0.385) |
| Herfindahl-Hirschman Index of NHs in HRR | 1.242 (−4.628 to 7.111) | −0.674 (−1.896 to 0.548) | 2.153* (0.739 to 3.567) | 1.940* (0.639 to 3.241) | 0.849 (−1.298 to 2.997) | −2.500 (−9.256 to 4.256) |
| Year: 2014 | −1.756* (−2.269 to −1.242) | −0.200* (−0.307 to −0.094) | −0.451* (−0.575 to −0.328) | −0.368* (−0.482 to −0.254) | −0.769* (−0.957 to −0.581) | −0.280 (−0.871 to 0.310) |
| Year: 2015 | −2.937* (−3.462 to −2.412) | −0.331* (−0.440 to −0.221) | −0.713* (−0.839 to −0.586) | −0.376* (−0.492 to −0.259) | −1.197* (−1.389 to −1.005) | −0.829* (−1.433 to −0.225) |
| Year: 2016 | −4.832* (−5.373 to −4.291) | −0.516* (−0.629 to −0.404) | −0.940* (−1.070 to −0.810) | −0.704* (−0.824 to −0.584) | −1.983* (−2.181 to 1.785) | −1.314* (−1.936 to −0.691) |
*
p-value < 0.05
Abbreviations: HHR – Hospital Referral Region, NH – Nursing Home