Physician Staffing Patterns Correlates of Nursing Home Care: An Initial Inquiry and Consideration of Policy Implications

Karuza, Jurgis; Katz, Paul R.

doi:10.1111/j.1532-5415.1994.tb06543.x

Cited by 54 publications

(23 citation statements)

References 13 publications

(11 reference statements)

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“…Support for a structured model can be found in the work of Roemer and Friedman (23) and others (24–26) who have shown an association between structured medical staff and quality of care. In our own work, which examines the impact of medical staff organization in nursing homes, physicians working within a closed staff model seemed to be more committed, knowledgeable about long-term care practice, and available (20). Existing policies, regulations, and care standards that define the role of the attending physician and medical director in the nursing home reinforce such a model (27, 28), as do programs for formal certification of medical directors (29).…”

Section: A Possible Solutionmentioning

confidence: 99%

Nursing Home Physician Specialists: A Response to the Workforce Crisis in Long-Term Care

Katz

Karuza²,

Intrator³

et al. 2009

Ann Intern Med

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101

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Marginalization of physicians in the nursing home threatens the overall care of increasingly frail nursing home residents who have medically complex illnesses. The authors propose that creating a nursing home medicine specialty, which recognizes the nursing home as a unique practice site, would go a long way toward remedying existing problems with care in skilled nursing facilities and would best serve the needs of the 1.6 million nursing home residents in the United States. Reviewing what is known about physician practice in nursing homes and hospitals, and taking a lead from the hospitalist movement, the specialty would be characterized in 3 dimensions: the degree of physicians’ commitment, physicians’ practice competencies, and the structure of the medical staff organization in which they practice. Challenges to the adoption of a nursing home specialist model include mainstream medicine’s failure to recognize the nursing home as a legitimate medical practice, the need for the nursing home industry and policymakers to appreciate the links between physician practice and quality, and assurance of financial viability. Implications for quality of care, health policy, and research needs are discussed in this article.

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Section: A Possible Solutionmentioning

confidence: 99%

Nursing Home Physician Specialists: A Response to the Workforce Crisis in Long-Term Care

Katz

Karuza²,

Intrator³

et al. 2009

Ann Intern Med

Self Cite

101

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“…It is also possible that only a small fraction of residents received their care from those physicians that were retained by employment arrangements, therefore it was important to include a measure of the degree to which residents received care from non-employed physicians. This latter measure had been used before to capture the related concept of open/closed practice staff model 2, 13,14 . Credentialing is another way a NH can control its physician resources.…”

Section: Introductionmentioning

confidence: 99%

Nursing Home Control of Physician Resources

Intrator

Lima

Wetle

2014

Journal of the American Medical Directors Association

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Objective Physician services are increasingly recognized as important contributors to quality care provision in nursing homes (NHs), but knowledge of ways in which NHs manage/ control physician resources is lacking. Data Primary data from surveys of NH Administrators and Directors of Nursing from a nationally representative sample of 1,938 freestanding U.S. NHs in 2009–2010 matched to Online Survey Certification and Reporting (OSCAR), aggregated NH Minimum Data Set (MDS) assessments and Medicare claims, and data from the Area Resource File (ARF). Methods The concept of NH Control of Physician Resources (NHCOPR) was measured using NH Administrators’ reports of management implementation of rules, policies, and procedures aimed at coordinating work activities. The NHCOPR scale was based on measures of formal relationships, physician oversight and credentialing. Scale values ranged from weakest (0) to tightest (3) control. Several hypotheses of expected associations between NHCOPR and other measures of NH and market characteristics were tested. Principal Findings The full NHCOPR score averaged 1.58 (SD=0.77) on the 0–3 scale. Nearly 30% of NHs had weak control (NHCOPR <= 1), 47.5% had average control (NHCOPR between 1 and 2), and the remaining 24.8% had tight control (NHCOPR > 2). NHCOPR exhibited good face- and predictive-validity as exhibited by positive associations with more beds, more Medicare services, cross coverage and number of physicians in the market. Conclusions The NHCOPR scale capturing NH’s formal structure of control of physician resources can be useful in studying the impact of NH’s physician resources on residents’ outcomes with potential for targeted interventions by education and promotion of NH administration of physician staff.

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“…Available research also points to better delivery of quality care for facilities that use the "closed" physician staffing models (only select, credentialed physicians can provide clinical care in the facility). 9 In the same context, research has shown that higher performance on certifications in internal medicine (IM) and family practice (FP) specialties lead to better utilization and patient outcomes. 10,11 This is relevant as IM and FP specialists most commonly serve as NH medical directors.…”

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confidence: 99%

Incentivizing Nursing Home Quality and Physician Performance

Nazir¹,

Arling²,

Katz³

2012

Journal of the American Medical Directors Association

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Physician Staffing Patterns Correlates of Nursing Home Care: An Initial Inquiry and Consideration of Policy Implications

Abstract: Medical organization and practice patterns emerge as important factors in considerations of nursing home quality. Results argue that, as in acute settings, limiting practice privileges in nursing homes may be a useful organizational strategy to improve quality of care.

Cited by 54 publications

References 13 publications

Nursing Home Physician Specialists: A Response to the Workforce Crisis in Long-Term Care

Nursing Home Physician Specialists: A Response to the Workforce Crisis in Long-Term Care

Nursing Home Control of Physician Resources

Incentivizing Nursing Home Quality and Physician Performance

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