The Regulatory Environment and Rural Hospital Long‐Term Care Strategies From 1997 to 2003

Fennell, Mary L.; Campbell, Susan

doi:10.1111/j.1748-0361.2006.00061.x

Cited by 12 publications

(5 citation statements)

References 18 publications

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“…30,31 Further, NHs located in rural areas may have different long-term care service use. 32 Hospital-based facilities were not included in the analysis because their services focus primarily on postacute care. Nursing homes with fewer than 20 beds were excluded from the analysis because smaller facilities may have different operating practices and data obtained from these homes provide unstable estimates because of the small number of residents.…”

Section: Methodsmentioning

confidence: 99%

Not So Black and White: Nursing Home Concentration of Hispanics Associated with Prevalence of Pressure Ulcers

Gerardo

Teno

Mor

2009

Journal of the American Medical Directors Association

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Objective To examine the association between the nursing home (NH) concentration of Hispanics and prevalence of pressure ulcer. Design Secondary data analysis using data from the national repository of the 2000 Minimum Data Set (MDS) and On-Line Survey Certification and Reporting (OSCAR) data. We used a multivariate logistic model, with the Huber-White correction to account for clustering of persons within a nursing facility, to examine the association of Hispanic NH concentration with the prevalence of pressure ulcers, after adjusting for resident level characteristics. Setting Five states with a high population of Mexican-Americans (California, New Mexico, Arizona, Colorado, and Texas). Participants A total of 74,343 persons (9.26% black, 11.28% Hispanic, 79.46% non-Hispanic white) in a NH located in 1 of these 5 states during the last quarter of 2000. Measurements The prevalence of Stage II–IV pressure ulcers was examined in the last quarter of 2000. Stage II–IV pressure ulcers, resident demographics, and medical illness data were documented by nursing staff on the MDS. Results Hispanics and non-Hispanic blacks had a higher prevalence of pressure ulcers than non-Hispanic whites (7.60%, 9.71% and 12.10%, respectively). A facility’s concentration of Hispanic residents was associated with prevalent pressure ulcers after adjustment for resident characteristics. Conclusions Residents in nursing homes in which there is a higher concentration of Hispanic residents are more likely to have a pressure ulcer.

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Section: Methodsmentioning

confidence: 99%

Not So Black and White: Nursing Home Concentration of Hispanics Associated with Prevalence of Pressure Ulcers

Gerardo

Teno

Mor

2009

Journal of the American Medical Directors Association

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“…These sorts of factors provide direct and measurable feedback to the organization about how well it is performing. "Institutional environments" involve the social and political structures to which organizations must conform, including public opinion, legal structures (41), professional expectations and ideologies, and regulatory structures (42)(43)(44)(45), which include state and federal reimbursement mechanisms and rates, and the expectations and reimbursement practices of major third-party payers within the community. Feedback from these environments may be explicit (such as receipt of accreditation) or normative (what the benchmark hospitals have adopted), but they are at best indirectly related to how well the organization is performing.…”

Section: External Factors Influencing Multidisciplinary Care Teamsmentioning

confidence: 99%

The Organization of Multidisciplinary Care Teams: Modeling Internal and External Influences on Cancer Care Quality

et al. 2010

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Quality cancer care is complex and depends upon careful coordination between multiple treatments and providers and upon technical information exchange and regular communication flow between all those involved in treatment (including patients, specialist physicians, other specialty disciplines, primary care physicians [PCPs], and support services) (1). Earlier in this supplement, Taplin and others have pointed out the challenges of transferring information and responsibility among providers and institutions; a problem at the interfaces of care. Advances in surgical procedures, chemotherapy, computer technology, and targeted molecular and radiation therapies have all led to an increase in multimodality therapy, which increases the number of interfaces among cancer specialists and other clinicians in the treatment of any single patient. Contemporary cancer care thus presents a paradox: The potential for unparalleled quality and sophisticated treatment is high, yet the number of potential "failure" events in the continuum of cancer treatment (2) has multiplied significantly. Each failure in communication between various physicians and care providers and every transition and interface miscue can result in delayed treatment planning and implementation, unnecessary duplication of tests, incomplete follow-up, increased patient anxiety, decreased patient satisfaction, and declines in quality of life.This article will examine a particular type of organizational structure focused on the interfaces between multiple specialists involved in cancer treatment: the multidisciplinary treatment care (MDC) team. This structure has been identified as one method of ensuring the exchange of patient-related and technical information between all physicians and support services involved in a patient's care. The setting and format of the MDC encourage active involvement of all actors (including the patient and his/her family) in the development of a care plan. Once formed, MDC team meetings can be convened at multiple times throughout the process of cancer care (Figure 1 in Taplin) (3) and can thus serve as an ongoing communication structure aimed at smoothing the transitions between multiple stages of care.MDC teams are the successors to the tumor conference, and they have been an arrangement for coordinating cancer care for at least 30 years (4,5). The health-care management literature advocates for more frequent use of MDC teams (6,7), and the National Cancer Institute has historically supported their development and diffusion, dating back to the cancer network demonstrations of the late 1970s and early 1980s (5,8), and through the National Cancer Institute Community Cancer Center Programs of recent times (9). However, little, if any empirical evidence exists on the prevalence, efficacy, and diffusion of MDC teams in cancer treatment or on their effectiveness in smoothing transitions across stages of cancer care.This article presents a targeted review of the literature (primarily since 2000) on what is known about various types of MDC ...

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“…As the trends in population aging continues in the United States, the demand for all forms of long‐term care is likely to increase in the coming decades. Meeting this rising demand is more challenging for rural areas because rural elderly have greater long‐term care needs than their urban counterparts (Fennell and Campbell ) and there are well‐documented differences in urban and rural long‐term care providers (Phillips, Hawes, and Williams ; Hutchinson, Hawes, and Williams ) . One dimension in which there are significant differences between urban‐rural providers is in the quality of care provided by nursing homes.…”

mentioning

confidence: 99%

The Urban‐Rural Disparity in Nursing Home Quality Indicators: The Case of Facility‐Acquired Contractures

Bowblis

Meng

Hyer

2012

Health Services Research

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Objective. To identify and quantify the sources of the urban-rural disparity in facility-acquired contracture rates in nursing homes. Data Sources. Survey inspection data of U.S. nursing homes from 1999 to 2008 and standardized national rural definition file from the Rural-Urban Commuting Area Codes. Study Design. We estimated regressions of facility-level contracture rate as a function of urban-rural categories (urban, micropolitan, small rural town, and isolated small rural town) and other related facility characteristics to identify size of the urban-rural disparity. We used Blinder-Oaxaca decomposition techniques to determine the extent to which the disparity is attributable to the differences in facility and aggregate resident characteristics. Principal Findings. Rural nursing homes have higher contracture rates than urban nursing homes. About half of the urban-rural disparity is explained by differences in observable characteristics among urban and rural nursing homes. Differences in staffing levels explain less than 5 percent of the disparity, case-mix explains 6-8 percent, and structure and operational characteristics account for 10-22 percent of the disparity. Conclusion. While a lower level and quality of staffing are a concern for rural nursing homes, facility structure and funding sources explain a larger proportion of the urbanrural disparity in the quality of care. Key Words. Quality of care, disparities, rural, nursing homes, contractures, decomposition As the trends in population aging continues in the United States, the demand for all forms of long-term care is likely to increase in the coming decades. Meeting this rising demand is more challenging for rural areas because rural elderly have greater long-term care needs than their urban counterparts (Fennell and Campbell 2007) and there are well-documented differences in urban and rural long-term care providers (Phillips, Hawes, and Williams

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The Regulatory Environment and Rural Hospital Long‐Term Care Strategies From 1997 to 2003

Cited by 12 publications

References 18 publications

Not So Black and White: Nursing Home Concentration of Hispanics Associated with Prevalence of Pressure Ulcers

Not So Black and White: Nursing Home Concentration of Hispanics Associated with Prevalence of Pressure Ulcers

The Organization of Multidisciplinary Care Teams: Modeling Internal and External Influences on Cancer Care Quality

The Urban‐Rural Disparity in Nursing Home Quality Indicators: The Case of Facility‐Acquired Contractures

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