APPENDIX Table 1.
Association between Nursing Home Physician Specialization and Regional Performance on Nursing Home Quality Measures: Subgroup Analysis
| 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 specialist physicians/1,000 beds | −0.562* (−0.730 to −0.393) | −0.087* (−0.122 to −0.051) | −0.010 (−0.051 to 0.031) | −0.068* (−0.106 to −0.030) | 0.024 (−0.038 to 0.087) | 0.059 (−0.138 to 0.257) |
| Percent of NHs part of chain | 0.006 (−0.006 to 0.017) | −0.002 (−0.005 to 0.001) | −0.006* (−0.009 to −0.003) | −0.004* (−0.007 to −0.002) | 0.003 (−0.002 to 0.007) | −0.031* (−0.044 to −0.018) |
| Percent of NHs that are for-profit | 0.003 (−0.010 to 0.016) | 0.000 (−0.003 to 0.003) | −0.001 (−0.003 to 0.003) | 0.008* (0.005 to 0.011) | 0.001 (−0.005 to 0.005) | −0.040* (−0.055 to −0.024) |
| Percent of stays covered by Medicaid | −0.018 (−0.051 to 0.015) | −0.000 (−0.007 to 0.007) | 0.022* (0.014 to 0.030) | −0.033* (−0.041 to −0.026) | −0.034* (−0.047 to −0.022) | −0.042* (−0.080 to −0.003) |
| Percent of stays covered by Medicare | −0.057* (−0.112 to −0.002) | 0.010 (−0.001 to 0.022) | 0.015* (0.001 to 0.028) | −0.023* (−0.036 to −0.011) | −0.021 (−0.041 to 0.001) | 0.030 (−0.035 to 0.095) |
| Average patient age in years | −0.708* (−0.817 to −0.599) | −0.053* (−0.075 to −0.030) | −0.038* (−0.065 to −0.011) | −0.043* (−0.067 to −0.018) | −0.067* (−0.107 to −0.026) | −0.639* (−0.767 to −0.511) |
| Percent of patients who are white | 0.057* (0.038 to 0.077) | −0.003 (−0.007 to 0.001) | 0.005* (0.001 to 0.010) | 0.014* (0.010 to 0.019) | 0.028* (0.021 to 0.035) | 0.055* (0.032 to 0.078) |
| Percent of patients who are female | −0.108* (−0.185 to −0.030) | 0.007 (−0.010 to 0.023) | 0.041* (0.022 to 0.060) | −0.013 (−0.030 to 0.004) | 0.083* (0.054 to 0.112) | −0.075 (−0.166 to 0.016) |
| RN to total staffing ratio | −0.068* (−0.085 to −0.052) | −0.019* (−0.022 to −0.015) | −0.007* (−0.011 to −0.003) | 0.004* (0.001 to 0.008) | −0.020* (−0.026 to −0.014) | 0.088* (0.068 to 0.107) |
| Direct care staff hours per patient day | −3.158* (−3.794 to −2.523) | −0.692* (−0.825 to −0.558) | 0.214* (0.058 to 0.369) | 0.049 (−0.094 to 0.192) | −0.329* (−0.566 to −0.093) | −4.837* (−5.582 to −4.091) |
| Percent of NHs with APPs (e.g., NPs) | 0.016* (0.006 to 0.027) | 0.005* (0.002 to 0.007) | 0.002 (−0.001 to 0.005) | −0.009* (−0.011 to −0.006) | 0.002 (−0.002 to 0.006) | 0.013* (0.001 to 0.025) |
| Average patient acuity index | −0.422 (−0.857 to 0.014) | 0.103* (0.011 to 0.194) | 0.248* (0.142 to 0.355) | 0.022 (−0.076 to 0.120) | 0.438* (0.275 to 0.600) | −0.137 (−0.648 to 0.374) |
| Herfindahl-Hirschman Index of NHs in HRR | −0.211 (−5.963 to 5.540) | −0.814 (−2.022 to 0.394) | 2.075* (0.666 to 3.484) | 1.882* (0.590 to 3.174) | 1.185 (−0.956 to 3.326) | −3.536 (−10.283 to 3.211) |
| Year: 2014 | −1.769* (−2.274 to −1.264) | −0.203* (−0.309 to −0.097) | −0.451* (−0.575 to −0.328) | −0.371* (−0.484 to −0.257) | −0.771* (−0.959 to −0.583) | −0.267 (−0.860 to 0.325) |
| Year: 2015 | −2.956* (−3.472 to −2.440) | −0.336* (−0.444 to −0.228) | −0.711* (−0.838 to −0.585) | −0.382* (−0.498 to 0.266) | −1.205* (−1.397 to −1.013) | −0.788* (−1.393 to −0.183) |
| Year: 2016 | −4.844* (−5.375 to −4.313) | −0.522* (−0.634 to −0.411) | −0.938* (−1.068 to −0.808) | −0.711* (−0.831 to −0.592) | −1.996* (−2.194 to −1.798) | −1.254* (−1.877 to −0.632) |
*
p-value < 0.05