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Using outcomes to make inferences about nursing home quality

EVALUATION & THE HEALTH PROFESSIONS 1998年第3期21卷 291-315页

作者： Spector, WD Mukamel, DB Agcy Hlth Care Policy & Res Rockville MD 20852 USA Univ Rochester Rochester NY 14627 USA

Recent concerns about containing the growth of public expenditures on nursing home care and the development of prospective and case-mix reimbursement systems,vith incentives for cast containment have increased the importance of monitoring quality in nursing homes. The current view is that quality assurance systems should include more outcome measures to improve quality This article discusses why it is difficult to develop facility-level outcome measures that can be used to evaluate and compare the quality of care of nursing homes. The article places the current interest in outcomes measures in its historical policy context and reviews important conceptual and methodological issues associated with outcome-based quality assessment The authors discuss the difficulty in isolating the facility effect when studying nursing home outcomes and implications of using different estimation approaches. In conclusion they discuss the need to integrate research with outcome-based quality assurance systems to allow ongoing evaluation and quality improvement.

关键词：偏倚(流行病学) 费用控制数据说明统计效应修正因子(流行病学) 医护疗养所/经济学医护疗养所/标准结果与过程评价(卫生保健)/方法结果与过程评价(卫生保健)/发展趋势质量保证卫生保健/方法质量保证卫生保健/发展趋势卫生保健质量偿还途径/发展趋势可重复性结果美国人类

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Trends in antibiotic use and cost and influence of case-mix and infection rate on antibiotic-prescribing in a long-term care facility

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AMERICAN JOURNAL OF INFECTION CONTROL 2003年第1期31卷 18-25页

作者： Mylotte, JM Neff, M SUNY Buffalo Sch Med & Biomed Sci Dept Med Buffalo NY 14260 USA SUNY Buffalo Sch Med & Biomed Sci Dept Microbiol Buffalo NY 14260 USA Cunningham Fahey Facil Loretto Residential Hlth Care Syracuse NY USA

Background: Antibiotic use and cost indicators have been developed specifically for the long-term care facility (LTCF) setting. Approximately 50% of the variation in these indicators was explained by the variation in infection rate. The objectives of this study were to further assess the utility of the antibiotic use and cost indicators in a different LTCF and to determine the correlation of case-mix and these indicators. Methods: Antibiotic use and cost indicators were collected monthly by unit (N = 10) and by physician (N = 6) at a 433-bed LTCF in Syracuse, New York, from February 1999 to September 2001. Indicators included incidence (number of antibiotic courses per 1000 resident care-days) of antibiotic use, antibiotic utilization ratio ([AUR];ratio of the number of antibiotic-days to the number of resident care-days), cost per antibiotic-day, and cost per resident care-day. Case-mix variation was measured with the case-mix index (CMI) of the Resource Utilization Group II system. Simple linear and multilinear regression analyses were used to evaluate correlations of continuous variables. Results: Among the 10 units or 6 physicians, there was a significant difference in the average values for all indicators. Correlation between unit- or physician-specific CMI and antibiotic use or cost indicators or infection rate was poor. However, there was a significant positive correlation between unit- or physician-specific infection rate and incidence of antibiotic use, AUR, and cost per resident care-day but not cost per antibiotic-day. With use of multilinear regression analysis to control for CMI and cost per antibiotic-day, infection rate was a significant predictor of incidence of antibiotic use (R-2 = 0.65;P < .001) and AUR (R-2 = 0.78;P < .001). Conclusions. This study provides further evidence that the antibiotic use and cost indicators developed specifically for LTCFs can detect significant variation among units within a facility and among physicians. However, ther

关键词：抗菌药/经济学抗菌药/治疗应用交叉感染/药物疗法交叉感染/经济学交叉感染/流行病学诊断相关患者组药费支出药物利用评审卫生保健费用感染控制/经济学线性模型多元分析纽约/流行病学医护疗养所/经济学医护疗养所/统计学和数值数据医师诊疗模式/统计学和数值数据前瞻性研究人类

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Control of the marketing effort in health care organizations

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Health Marketing Quarterly 1984年第4期1卷 83-100页

作者： Suver, James D. Miller, John A. School of Public Heallh University of North Carolina at Chapel Hill Chapel Hill United States College of Business and Management University of Colorado Colorado United States

No abstract available for this article.

关键词：成本及成本分析效率卫生服务使用研究/组织和管理医护疗养所/经济学组织目标/经济学

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EVALUATING RELIABILITY - A COST-EFFECTIVENESS APPROACH

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EVALUATION & THE HEALTH PROFESSIONS 1986年第3期9卷 361-375页

作者： HOGAN, AJ MICHIGAN STATE UNIV COLL HUMAN MEDE LANSINGMI 48824 USA

This study derives the economic costs of misclassification in nursing home patient classification systems. These costs are then used as weights to estimate the reliability of a functional assessment instrument applied to 290 Veterans Administration nursing home patients. The weighted kappa is used to measure reliability and the results were generally favorable. Use of the unweighted kappa indicated significant reliability problems. It is suggested that reliability must be redefined and remeasured with each substantively new application of an assessment instrument.

关键词：日常生活活动费用效益分析护理估计/经济学医护疗养所/经济学病人/分类美国美国退伍军人事务部人类

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Evaluating the effectiveness of nursing home administrators

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Evaluation & the Health Professions 1982年第2期5卷 145-169页

作者： Fottler, Myron D. Smith, Howard L. University of Alabama United States University of New Mexico United States

There has been little previous research on the determinants of the effec(tiveness of health care administrators. This research gap pertains to *'irtuallv all health care areas but is especiallv germane to the long-term care field, which has only recently witnessed professional growth in nursing home associations and administrator licensing, education, and ethical behavior. The present studvi evxamines the effectivenes of nursing home administrators according to economic' criteria (costs and profits per patient per dav). Multiple regression analhsis was used to determine structure and process variables related to those effectiveness measures. Results indicate that process variables which are controllable bi, administrators themselves account for the bulk of the variabilitY in nursing home administrator efftctiveness. © 1982, SAGE Publications. All rights reserved.

关键词：加利福尼亚效率评价研究卫生设施负责人员医护疗养所/经济学回归分析人类

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HOTEL AND DEPENDENCY COSTS OF RESIDENTS IN OLD PEOPLES HOMES

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JOURNAL OF SOCIAL POLICY 1978年第JAN期7卷 1-22页

作者： DAVIES, B KNAPP, MRJ

A comparison of costs to the organization of alternative forms of care requires estimates for similar types of client. The degree of dependency is the main characteristic in which comparability is necessary with regard to services for the aged. This paper presents estimates of the costs incurred in providing residential care for clients of four degrees of incapacity for self-care – the capacity implicit in Bevan's residential hotel model of the old people's home, and three progressively more severe states of dependency. The estimates are for two cost concepts – average (unit) costs and marginal costs (the cost of caring for an additional person). The paper also estimates both long-run costs (costs that it is appropriate to take into account in decisions in which capital investment in new plant is being considered), and short-run costs (costs that it is appropriate to consider when the issue is the allocation of existing capacity between client groups). It also examines the consequences of the size of the home with regard to costs. Inter alia the paper shows:(a) that the size of home beyond which costs do not fall with scale provides for as many as fifty places (equivalent to an average daily census of forty-six residents); and(b) that, although the dependency components of costs are much smaller than the hotel components, dependency costs are large enough for it to be important to base comparisons of alternative forms of care on estimates of costs for clients which are comparable with respect to dependency.

关键词：成本及成本分析大不列颠老人疗养院/经济学模型理论医护疗养所/经济学

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Evaluation of a prospective payment system for VA contract nursing homes

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EVALUATION & THE HEALTH PROFESSIONS 1996年第4期19卷 423-442页

作者： Weaver, FM Conrad, KJ Guihan, M Byck, GR Manheim, LM Hughes, SL NORTHWESTERN UNIV EVANSTONIL 60208 UNIV ILLINOIS CHICAGOIL 60680

An evaluation of a pilot program for community nursing home care reimbursement by Department of Veterans Affairs Medical Centers (VAMCs) war undertaken Eight VAMCs began using the Enhanced Prospective Payment System (EPPS) in 1992. These sites were compared to eight customary payment sites in a pretest/posttest quasi-experimental design. Outcomes included access to care, administrative workload quality of care, and cost. As expected, per diem costs were significantly higher for EPPS than customary reimbursement patients ($106 vs. $87). However EPPS sites placed veterans more quickly (81 days vs. 113 days;p < .01) than comparison sites and reduced administrative workload associated with placement. EPPS sites also increased the number of Medicare-certified homes under contract (76% vs. 54%) and placed significantly more veterans who received therapy (20% vs. < 1%). Savings in hospital days more than offset the increased cost of nursing home placement. Because the findings were attributed largely to a few veterans with long lengths of hospital stay, the early success of EPPS may diminish as the backlog of these long-stay patients decreases.

关键词：卡方分布合同业务/经济学卫生保健费用医院退伍军人/经济学医护疗养所/经济学结果评价(卫生保健) 试点项目方案评价预期支付系统美国美国退伍军人事务部人类

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Long-term care and cosi control: A critical analysis

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Health and Social Work 1979年第1期4卷 61-88页

作者： Cohen, Marcia B. Florence Heller Graduate School for Advanced Studies in Social Welfare Brandeis University Waltham MA United States

The rapidly increasing cost of providing health care in the United States has led to growing concern among government officials, health care professionals, and the public at large. This article evaluates the measures taken by one state, New York, to reduce costs in the area of long-term care and analyzes the impact that these measures have had on patients. © 1979 by National Association of Social Workers, Inc.

关键词：固位长期医疗/经济学长期医疗/立法和法学长期医疗/心理学 Medicare/经济学纽约医护疗养所/经济学病人接受卫生保健的程度病人入院社会隔绝美国老年人女(雌)性人类

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WILLINGNESS TO PAY FOR PUBLICLY-PROVIDED GOODS - A POSSIBLE MEASURE OF BENEFIT

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JOURNAL OF HEALTH ECONOMICS 1990年第1期9卷 103-118页

作者： DONALDSON, C UNIV NEWCASTLE UPON TYNE NEWCASTLE TYNE NE2 4AAENGLAND

The results presented in this paper arise from a U.K.-based study aimed at determining peoples' willingness to pay for two publicly-provided goods, namely continuing-care for elderly people in either hospital or National Health Service (NHS) nursing homes. Seventy-one per cent of respondents provided evaluations which could contribute to the analysis which showed that the group which preferred NHS nursing-home care could potentially compensate the group which preferred hospital care and still remain better off, thus rendering NHS nursing-home care the efficient option to undertake. No variable could be found which discriminated between those who could place a value on both types of care and those who could not. The willingness-to-pay methodology is very experimental in this context and should be investigated thoroughly before its widespread adoption in the evaluation of health care techniques.

关键词：健康态度用户参与/经济学费用效益分析/方法数据收集评价研究家庭/心理学筹资政府/统计学和数值数据筹资个人/统计学和数值数据大不列颠住院/经济学模型统计学医护疗养所/经济学公费医疗老年人人类

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It's not just happening in acute care

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Hospital Topics 1986年第6期64卷 25-28页

作者： Cohen, Adrene NY United States

Click to increase image sizeClick to decrease image size

关键词：日常生活活动诊断相关患者组长期医疗/分类 Medicaid 纽约医护疗养所/经济学试点项目偿还途径美国人类

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