The Effect of State Regulatory Stringency on Nursing Home Quality

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 seve...

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Published in:Health services research Vol. 47; no. 5; pp. 1791 - 1813
Main Authors: Mukamel, Dana B., Weimer, David L., Harrington, Charlene, Spector, William D., Ladd, Heather, Li, Yue
Format: Journal Article
Language:English
Published: United States Blackwell Publishing Ltd 01-10-2012
Health Research and Educational Trust
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Abstract 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.
AbstractList 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.
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. Key Words. Nursing homes, quality of care, regulation, cost-effectiveness, comparative effectiveness
OBJECTIVETo test the hypothesis that more stringent quality regulations contribute to better quality nursing home care and to assess their cost-effectiveness. DATA SOURCES/SETTINGPrimary and secondary data from all states and U.S. nursing homes between 2005 and 2006. STUDY DESIGNWe 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 COLLECTIONAll 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 FINDINGSRegulatory 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. CONCLUSIONSQuality 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.
The purpose of this paper is to test the hypothesis that more stringent quality regulations contribute to better quality nursing home care and to assess their cost-effectiveness. Primary and secondary data were from all states and US nursing homes between 2005 and 2006. 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. 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. 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. 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. [PUBLICATION ABSTRACT]
To test the hypothesis that more stringent quality regulations contribute to better quality nursing home care and to assess their cost-effectiveness. Primary and secondary data from all states and U.S. nursing homes between 2005 and 2006. 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. 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. 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. 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. Adapted from the source document.
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.
To test the hypothesis that more stringent quality regulations contribute to better quality nursing home care and to assess their cost-effectiveness. Primary and secondary data from all states and U.S. nursing homes between 2005 and 2006. 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. 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. 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. 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.
Audience Trade
Author Harrington, Charlene
Mukamel, Dana B.
Li, Yue
Weimer, David L.
Ladd, Heather
Spector, William D.
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  givenname: David L.
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  givenname: Charlene
  surname: Harrington
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  givenname: Heather
  surname: Ladd
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  organization: Health Policy Research Institute, University of California, Irvine, CA, Irvine
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  givenname: Yue
  surname: Li
  fullname: Li, Yue
  organization: Division of Health Policy and Outcomes Research, Department of Community and Preventive Medicine, University of Rochester Medical Center, NY, Rochester
BackLink https://www.ncbi.nlm.nih.gov/pubmed/22946859$$D View this record in MEDLINE/PubMed
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Snippet Objective To test the hypothesis that more stringent quality regulations contribute to better quality nursing home care and to assess their cost‐effectiveness....
To test the hypothesis that more stringent quality regulations contribute to better quality nursing home care and to assess their cost-effectiveness. Primary...
Data Collection. All states' licensing and certification offices were surveyed to obtain data about deficiencies. Secondary data included the Minimum Data Set,...
Objective, To test the hypothesis that more stringent quality regulations contribute to better quality nursing home care and to assess their...
The purpose of this paper is to test the hypothesis that more stringent quality regulations contribute to better quality nursing home care and to assess their...
OBJECTIVETo test the hypothesis that more stringent quality regulations contribute to better quality nursing home care and to assess their cost-effectiveness....
To test the hypothesis that more stringent quality regulations contribute to better quality nursing home care and to assess their cost-effectiveness. Primary...
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StartPage 1791
SubjectTerms Activities of Daily Living
Bedsores
California
comparative effectiveness
Cost analysis
Cost benefit analysis
Cost effectiveness
Decubitus ulcer
Government Regulation
Hotels and motels
Humans
Introducing The Best of The Academyhealth Annual Research Meeting
Laws, regulations and rules
Least-Squares Analysis
Medical care
Medical care quality
Medicare
Nursing homes
Nursing Homes - economics
Nursing Homes - legislation & jurisprudence
Nursing Homes - manpower
Nursing Homes - standards
Personnel Staffing and Scheduling - statistics & numerical data
Pressure Ulcer - epidemiology
Quality adjusted life years
Quality Indicators, Health Care - statistics & numerical data
Quality management
Quality of care
Quality of Health Care - legislation & jurisprudence
Quality of Health Care - standards
Regulation
Regulations
State Government
State regulation
Studies
United States
Urinary incontinence
Urinary Incontinence - epidemiology
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Title The Effect of State Regulatory Stringency on Nursing Home Quality
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https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fj.1475-6773.2012.01459.x
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Volume 47
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