APPENDIX Table 2.
Association between Nursing Home Advanced Practitioner 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 APs per 1,000 beds | 0.073 (−0.021 to 0.166) | −0.001 (−0.020 to 0.019) | 0.009 (−0.014 to 0.031) | −0.008 (−0.028 to 0.013) | −0.041* (−0.075 to −0.007) | 0.159* (0.051 to 0.266) |
| Percent of NHs part of chain | 0.008 (−0.003 to 0.020) | −0.002 (−0.004 to 0.001) | −0.006* (−0.009 to −0.003) | −0.004* (−0.007 to −0.002) | 0.002 (−0.002 to 0.007) | −0.030* (−0.044 to −0.017) |
| Percent of NHs that are for-profit | 0.002 (−0.012 to 0.016) | −0.000 (−0.003 to 0.003) | −0.000 (−0.003 to 0.003) | 0.007* (0.004 to 0.011) | 0.001 (−0.005 to 0.005) | −0.040* (−0.056 to −0.024) |
| Percent of stays covered by Medicaid | −0.022 (−0.057 to 0.011) | −0.001 (−0.008 to 0.006) | 0.022* (0.014 to 0.030) | −0.034* (−0.041 to −0.027) | −0.035* (−0.047 to −0.022) | −0.039* (−0.078 to −0.001) |
| Percent of stays covered by Medicare | −0.077* (−0.134 to −0.020) | 0.008 (−0.004 to 0.020) | 0.013 (−0.000 to 0.027) | −0.024* (−0.037 to −0.011) | −0.016 (−0.037 to 0.005) | 0.016 (−0.050 to 0.081) |
| Average patient age in years | −0.731* (−0.842 to −0.620) | −0.055* (−0.078 to −0.032) | −0.039* (−0.066 to −0.012) | −0.044* (−0.068 to −0.019) | −0.062* (−0.103 to −0.022) | −0.652* (−0.780 to −0.525) |
| Percent of patients who are white | 0.066* (0.047 to 0.086) | −0.002 (−0.006 to 0.003) | 0.006* (0.001 to 0.011) | 0.015* (0.011 to 0.019) | 0.027* (0.019 to 0.034) | 0.059* (0.036 to 0.082) |
| Percent of patients who are female | −0.100* (−0.179 to −0.021) | 0.009 (−0.008 to 0.025) | 0.041* (0.022 to 0.060) | −0.011 (−0.028 to 0.007) | 0.086* (0.057 to 0.115) | −0.090 (−0.181 to 0.001) |
| RN to total staffing ratio | −0.087* (−0.103 to −0.070) | −0.021* (−0.025 to −0.018) | −0.008* (−0.012 to −0.004) | 0.002 (−0.001 to 0.006) | −0.018* (−0.024 to −0.012) | 0.085* (0.066 to 0.104) |
| Direct care staff hours per patient day | −3.503* (−4.140 to −2.866) | −0.746* (−0.879 to −0.613) | 0.208* (0.055 to 0.362) | 0.006 (−0.135 to 0.147) | −0.318* (−0.550 to −0.085) | −4.786* (−5.518 to −4.053) |
| Percent of NHs with APPs (e.g., NPs) | 0.006 (−0.006 to 0.018) | 0.004* (0.001 to 0.006) | 0.002 (−0.001 to 0.005) | −0.009* (−0.011 to −0.006) | 0.005* (0.001 to 0.009) | 0.004 (−0.010 to 0.017) |
| Average patient acuity index | −0.449* (−0.892 to −0.006) | 0.097* (0.005 to 0.189) | 0.249* (0.142 to 0.356) | 0.016 (−0.082 to 0.114) | 0.433* (0.271 to 0.595) | −0.109 (−0.619 to 0.400) |
| Herfindahl-Hirschman Index of NHs in HRR | 2.443 (−3.407 to 8.294) | −0.490 (−1.710 to 0.731) | 2.175* (0.766 to 3.584) | 2.084* (0.785 to 3.383) | 0.793 (−1.344 to 2.931) | −2.608 (−9.337 to 4.120) |
| Year: 2014 | −1.771* (−2.284 to −1.257) | −0.202* (−0.309 to −0.095) | −0.452* (−0.576 to −0.328) | −0.369* (−0.483 to −0.255) | −0.766* (−0.954 to −0.579) | −0.287 (−0.878 to 0.303) |
| Year: 2015 | −2.985* (−3.510 to −2.460) | −0.336* (−0.446 to −0.227) | −0.714* (−0.841 to −0.588) | −0.379* (−0.496 to −0.263) | −1.190* (−1.382 to −0.999) | −0.844* (−1.448 to −0.240) |
| Year: 2016 | −4.901* (−5.443 to −4.360) | −0.525* (−0.638 to −0.412) | −0.942* (−1.073 to −0.812) | −0.710* (−0.830 to −0.590) | −1.974* (−2.172 to −1.776) | −1.332* (−1.955 to −0.709) |
*
p-value < 0.05