A longitudinal analysis of nursing home outcomes.
OBJECTIVE
To investigate resident and facility attributes associated with long-term care health outcomes in nursing homes.


METHODS
Quarterly Management Minutes Questionnaire (MMQ) survey data for Medicaid case-mix reimbursement of nursing homes in Massachusetts from 1991 to 1994, for specification of outcomes and resident attributes. Facility attributes are specified from cost report data.


METHODS
Multivariate logistic and "state-dependence" regression models are estimated for survival, ADL functional status, incontinence status, and mental status outcomes from longitudinal residence histories of Medicaid residents spanning 3 to 36 months in length. Outcomes are specified to be a function of resident demographic and diagnostic attributes and facility-level operating and nurse staffing attributes.


RESULTS
The estimated parameters for resident demographic and diagnostic attributes showed a great deal of construct validity with respect to clinical expectations regarding risk factors for adverse outcomes. Few facility attributes were associated with outcomes generally, and none was significantly associated with all four outcomes.


CONCLUSIONS
The absence of uniform associations between facility attributes and the various long-term care health outcomes studied suggests that strong facility performance on one health outcome may coexist with much weaker performance on other outcomes. This has implications for the aggregation of individual facility performance measures on multiple outcomes and the development of overall outcome performance measures.
Gerontology Institute, University of Massachusetts, Boston 02125-3393, USA.
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Porell
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Caro
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Silva
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Monane
D000203:Activities of Daily Living; D000368:Aged / Q000706:statistics & numerical data*; D003953:Diagnosis-Related Groups / Q000191:economics; D005260:Female; D015577:Geriatric Assessment; D006302:Health Services Research; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008404:Massachusetts; D008484:Medicaid / Q000458:organization & administration; D015999:Multivariate Analysis; D009735:Nursing Homes / Q000592:standards* / Q000639:trends; D017063:Outcome Assessment, Health Care / Q000639:trends*; D012044:Regression Analysis; D012051:Reimbursement Mechanisms / Q000458:organization & administration; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D014481:United States