Improving the quality of nursing home outcomes. Are adequacy- or incentive-oriented policies more effective?
ABSTRACT Recent debates over health policy have tended to be between procompetitive solutions and proregulatory ones. This dichotomy, however, seems to be less descriptive of the policy debate over ways to improve nursing home quality. This article argues that a more useful distinction may be between adequacy- and incentive-oriented policies. The nursing home industry and others have argued that the financial and physical resources at the disposal of nursing homes have been inadequate to produce acceptable quality levels. Whether quality requires more resources is tested using the 1983 Iowa Outcome Oriented Survey, but none of the quality measures constructed from these data were significantly associated with higher average costs. On the other hand, nonprofit nursing homes, nursing homes with more professional workers (nurses), and nursing homes that cater to private patients have incentives that may motivate them to provide better quality. These factors were often significantly associated with a variety of the quality measures, suggesting that policies based on incentives may be more effective than adequacy-oriented policies.
SourceAvailable from: Joshua Wiener
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ABSTRACT: Introduction: The aims of this study were to describe the quality of life (QoL) of nursing-home residents with dementia and their balance, mobility, muscle strength and daily life activity, as well as to examine the associations between QoL and levels of balance, mobility, muscle strength and daily life activity. Methods: The study is cross sectional, and 170 nursing-home residents with dementia were included. Tests: "The quality of life in late-stage dementia scale" (QUALID), Berg Balance Scale, comfortable walking speed, maximum walking speed, 30-s sit-to-stand, Barthel Index, Clinical Dementia Rating Scale, the Clock Drawing Test and the Mini-Mental State Examination (MMSE) were used. Results: Our study showed that nursing-home residents with dementia are a heterogeneous group regarding registrations of QUALID and physical function measures. The scores on the QUALID ranged from 11 to 41 points. Higher scores on the 30-s sit-to-stand and Berg Balance Scale were associated with a better QUALID. For comfortable, as well as maximum, walking speed there was a trend towards better QUALID results for those participants with higher walking speed. Conclusions: Good muscle strength and balance were the most important physical performance variables significantly associated with a good QUALID score.International Journal of Environmental Research and Public Health 12/2013; 10(12):6672-86. DOI:10.3390/ijerph10126672 · 1.99 Impact Factor
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ABSTRACT: The incentive to provide nursing home quality depends, in part, on whether the state Medicaid reimbursement system is prospective or retrospective in nature. This paper examines the effect of state-level Medicaid reimbursement methods on the provision of quality in the context of bed constraint regulations that may influence market tightness. A three-part estimation strategy is constructed around the idea that a change in the Medicaid reimbursement method may affect both a facility's payer mix and the provision of quality. Across a range of quality measures, this multi-part model did not show nursing home quality to be significantly higher under a retrospective reimbursement system as compared with a prospective-based system of reimbursement. This finding holds regardless of whether the analysis was isolated to those markets with the tightest supply of beds or those homes that care for predominantly Medicaid residents.Health Services and Outcomes Research Methodology 01/2002; 3(1):21-39. DOI:10.1023/A:1021578707616