Document Detail


The effect of state regulatory stringency on nursing home quality.
MedLine Citation:
PMID:  22946859     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To test the hypothesis that more stringent quality regulations contribute to better quality nursing home care and to assess their cost-effectiveness.
DATA SOURCES/SETTING: Primary and secondary data from all states and U.S. nursing homes between 2005 and 2006.
STUDY DESIGN: We estimated seven models, regressing quality measures on the Harrington Regulation Stringency Index and control variables. To account for endogeneity between regulation and quality, we used instrumental variables techniques. Quality was measured by staffing hours by type per case-mix adjusted day, hotel expenditures, and risk-adjusted decline in activities of daily living, high-risk pressure sores, and urinary incontinence.
DATA COLLECTION: All states' licensing and certification offices were surveyed to obtain data about deficiencies. Secondary data included the Minimum Data Set, Medicare Cost Reports, and the Economic Freedom Index.
PRINCIPAL FINDINGS: Regulatory stringency was significantly associated with better quality for four of the seven measures studied. The cost-effectiveness for the activities-of-daily-living measure was estimated at about 72,000 in 2011/ Quality Adjusted Life Year.
CONCLUSIONS: Quality regulations lead to better quality in nursing homes along some dimensions, but not all. Our estimates of cost-effectiveness suggest that increased regulatory stringency is in the ballpark of other acceptable cost-effective practices.
Authors:
Dana B Mukamel; David L Weimer; Charlene Harrington; William D Spector; Heather Ladd; Yue Li
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-09-04
Journal Detail:
Title:  Health services research     Volume:  47     ISSN:  1475-6773     ISO Abbreviation:  Health Serv Res     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-09-18     Completed Date:  2012-11-28     Revised Date:  2013-10-17    
Medline Journal Info:
Nlm Unique ID:  0053006     Medline TA:  Health Serv Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1791-813     Citation Subset:  IM    
Copyright Information:
© Health Research and Educational Trust.
Affiliation:
Health Policy Research Institute, University of California, Irvine, 100 Academy, Suite 110, Irvine, CA 92697-5800, USA. dmukamel@uci.edu
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MeSH Terms
Descriptor/Qualifier:
Activities of Daily Living
Cost-Benefit Analysis
Government Regulation
Humans
Least-Squares Analysis
Nursing Homes / economics,  legislation & jurisprudence*,  manpower,  standards
Personnel Staffing and Scheduling / statistics & numerical data
Pressure Ulcer / epidemiology
Quality Indicators, Health Care / statistics & numerical data
Quality of Health Care / legislation & jurisprudence*,  standards
State Government*
United States
Urinary Incontinence / epidemiology
Grant Support
ID/Acronym/Agency:
AG027420/AG/NIA NIH HHS; R01 AG027420/AG/NIA NIH HHS
Comments/Corrections

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