Organizational Characteristics and the Adoption of Electronic Health Records Among Nursing Homes in One Southern State

Abstract

Electronic health records (EHRs) can improve quality of care and patient safety, as demonstrated in a variety of health care settings. However, greater use of EHRs in nursing homes (NHs) is needed. To understand which NHs have and have not adopted EHR systems, all federally certified NHs in Arkansas ( n = 223) were surveyed, with 27.9% responding. Non-responders were similar to responders on all characteristics except for staffing skill mix, with responders having a higher skill mix than non-responders. Two thirds of responding Arkansas NHs reported having an EHR system in use (69.8%), while only a few reported no plans for an EHR system (4.8%). NHs with greater resources and in competitive markets were more likely to implement EHR systems. Full implementation across all NHs may require intervention, which should be explored in future research. In addition, future investigation should consider the level of interoperability of EHR systems that are in place among NHs.

Incentivizing Better Quality of Care: The Role of Medicaid and Competition in the Nursing Home Industry

“…To mitigate these concerns, I assume that nursing homes compete in locally segmented markets both for new residents and inputs (e.g., nurses). In my primary specification, I assume that counties define segmented markets suggesting that lagged costs from nursing homes located in different counties, A C −c, t− 3,4,5 p( j) , do not affect the optimal staffing and pricing decision directly and are therefore excluded from equation (1). However, these costs affect the Medicaid reimbursement rate, see equation (2), and can therefore serve as instrumental variables.…”

“…Assumption (SP) may be violated if shocks to staffing decisions, governed by equation (1), are spatially as well as serially correlated. Assumption (SE) may be violated if local staffing shocks are serially correlated, adding bias if they affect the instrumental variable, average costs in other counties, A C −c, t− 3,4,5 p( j) , as well.…”

“…While each approach relies on strong assumptions, they all indicate that the key findings of the main analysis are robust to potential rationing, perhaps because Pennsylvania does not restrict entry and capacity investments through a CON law. 1 The main contribution of this paper is to provide new evidence on the dependence of the quality of nursing home care on Medicaid reimbursement rates and local market power. Previous studies investigated the link between Medicaid reimbursement rates and nurse staffing ratios, both theoretically (Scanlon 1980, Ma 1994, Rogerson 1994) and empirically (Gertler 1989, Grabowski 2001, Harrington et al 2008, Feng et al 2008).…”

“…My analysis focuses on explaining the large cross-sectional differences in the quality of care. To this end, I adopt a simpler static 1 However, the welfare gains resulting from Medicaid increases are reduced if rationing crowds out seniors who would otherwise derive high utility from nursing home care. 2 Earlier studies have argued that increases in Medicaid rates may lower the quality of care if rationing leads to excess demand of Medicaid beneficiaries (Scanlon 1980).…”

The Association Between Nursing Home Information Technology Maturity and Urinary Tract Infection Among Long-Term Residents

“…Information technology (IT) systems that facilitate tracing high-risk individuals, identifying antibiotic clinical indications, enhancing culture results, and offering decision support could help staff identify UTIs and proper interventions earlier (Felix et al, 2021). However, disparities in adoption and use of NH IT systems caused by lack of investment in IT infrastructure, preparation, and training could place vulnerable residents at greater risk of UTI (Ko et al, 2018).…”