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 |
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01-10-2012
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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. |
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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. |
Author_xml | – sequence: 1 givenname: Dana B. surname: Mukamel fullname: Mukamel, Dana B. email: dmukamel@uci.edu organization: Health Policy Research Institute, University of California, Irvine, CA, Irvine – sequence: 2 givenname: David L. surname: Weimer fullname: Weimer, David L. organization: LaFollette School of Public Affairs, University of Wisconsin - Madison, WI, Madison – sequence: 3 givenname: Charlene surname: Harrington fullname: Harrington, Charlene organization: Department of Social & Behavioral Sciences, University of California, CA, San Francisco – sequence: 4 givenname: William D. surname: Spector fullname: Spector, William D. organization: Agency for Healthcare Research & Quality, MD, Rockville – sequence: 5 givenname: Heather surname: Ladd fullname: Ladd, Heather organization: Health Policy Research Institute, University of California, Irvine, CA, Irvine – sequence: 6 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 |
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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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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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