title: The impact of market and organizational characteristics on nursing care facility service innovation: a resource dependency perspective.
abstract: OBJECTIVE
  Using resource dependency theory as a conceptual framework, this study investigates both the organizational and environmental factors associated with an emerging health care service delivery innovation, the provision of specialty care in designated units in nursing care facilities. We consider two types of specialty units, Alzheimer's Disease and subacute care.
  
  
  METHODS
  The Medicare/Medicaid Automated Certification Survey (MMACS) data file was merged with local market area data obtained from the 1992 Area Resource File and with state level regulatory data.
  
  
  METHODS
  The likelihood of providing Alzheimer's Disease or subacute care in dedicated units was estimated by separate logistic regressions.
  
  
  RESULTS
  Results indicate that facilities with fewer Medicare patients are more likely to operate a dedicated Alzheimer's care unit, while facilities located in markets with a large HMO population and greater hospital supply are more likely to operate a subacute care unit. While competition among nursing homes, for the most part, is an incentive to innovate, greater regulatory stringency appears to constrain the development of specialty care units of both types. Finally, organizational characteristics (e.g., size and proprietary status) appear to be important enabling factors influencing the propensity to provide specialty care in dedicated units.
  
  
  CONCLUSIONS
  Nursing care facilities are moving toward providing specialty care units partly as a response to a growing demand by resource providers and to maintain a competitive edge in tighter markets. Loosening regulation directed at cost containment would further encourage the development of specialty care but should be preceded by some evaluation of population needs for specialty care and the effectiveness of specialty care units.
authors.affiliation: Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor 48109-2029, USA.
authors.forename: J
authors.initials: J
authors.lastname: Banaszak-Holl
authors.forename: J S
authors.initials: JS
authors.lastname: Zinn
authors.forename: V
authors.initials: V
authors.lastname: Mor
mesh_terms: D000544:Alzheimer Disease / Q000451:nursing; D003363:Cost Control; D004059:Diffusion of Innovation; D004465:Economic Competition; D005161:Facility Regulation and Control; D006295:Health Resources; D006302:Health Services Research; D006801:Humans; D016015:Logistic Models; D008389:Marketing of Health Services; D006278:Medicare; D009936:Organizational Innovation; D011383:Progressive Patient Care / Q000458:organization & administration; D012866:Skilled Nursing Facilities / Q000458:organization & administration*; D014481:United States