ABSTRACT
This study identifies structural characteristics of VA nursing homes that are associated with the best patient outcomes. We evaluated risk-adjusted rates of pressure ulcer development in VA nursing homes and related these rates to facility size, staffing patterns, teaching nursing home status, and rural versus urban locale. Higher rates of pressure ulcer development were seen among urban teaching nursing homes and among nursing homes associated with both larger and smaller VA hospitals. Staffing patterns had a complex association with pressure ulcer development, and smaller nursing home staffs were not clearly associated with higher rates. For multivariate modeling, only hospital size and staffing remained significant independent predictors of pressure ulcer development. These results emphasize that while structural characteristics of VA nursing homes can provide insights about care, improving the quality of care in this setting will require a much greater understanding of how nursing homes are organized to meet patient needs.
Subject(s)
Homes for the Aged/standards , Nursing Homes/standards , Outcome Assessment, Health Care , Pressure Ulcer/epidemiology , United States Department of Veterans Affairs , Aged , Benchmarking , Homes for the Aged/organization & administration , Humans , Linear Models , Multivariate Analysis , Nursing Homes/organization & administration , United States/epidemiologyABSTRACT
Medicare's Prospective Payment System pays U.S. teaching hospitals for the indirect costs of medical education based on a regression coefficient in a cost function. In regression studies using health care data, it is common for explanatory variables to be measured imperfectly, yet the potential for measurement error is often ignored. In this paper, U.S. Department of Veterans Affairs data is used to examine issues of health care production estimation and the use of regression estimates like the teaching adjustment factor. The findings show that measurement error and persistent multicollinearity confound attempts to have a large degree of confidence in the precise magnitude of parameter estimates.
Subject(s)
Education, Medical, Graduate/economics , Efficiency, Organizational/economics , Hospitals, Teaching/economics , Medicare/economics , Prospective Payment System/economics , Confounding Factors, Epidemiologic , Efficiency, Organizational/statistics & numerical data , Hospitals, Veterans/economics , Internship and Residency/economics , Medical Staff, Hospital/economics , Models, Economic , Patient Discharge , Regression Analysis , United States , Workload/statistics & numerical dataABSTRACT
The U.S. Department of Veterans Affairs operates a hospital system that distributes a national global budget to 159 hospital units. Over recent years, cost containment and downward budgetary pressures have affected hospital performance and the quality of care delivered in unknown ways. This article examines hospital staffing levels as potential performance measures. We first develop a regression model to estimate the number and types of clinical staff required to meet current inpatient workloads at VA medical centers. We are able to improve on previous analyses by employing better data on physicians and by evaluating the behavior of hospitals in consecutive years. Our findings provide managers of hospital systems with promising new approaches for comparing hospital production processes and more information on the effects of global budgeting on individual hospital staffing within systems.
