title: Relationship between regulatory status, quality of care, and three-year mortality in Canadian residential care facilities: a longitudinal study.
abstract: OBJECTIVE
  To compare the mortality rate in regulated and unregulated facilities, controlling for confounding variables, and investigate the effect of care quality on residents' length of survival.
  
  
  METHODS
  At baseline, subjects were assessed in their living environment with respect to their functional autonomy, cognitive abilities, and quality of care. Vital status, disease-related information, and hospitalization data were retrieved three years later from the subjects' medical files.
  
  
  METHODS
  A three-year follow-up study of 299 residents from 88 long-term care facilities located in the province of Quebec, Canada. The effect of regulatory status and quality of care on length of survival was investigated by means of multivariable Cox proportional hazards regression models, from both traditional and competing risks perspectives.
  
  
  RESULTS
  Controlling for age, comorbidity, and baseline functional abilities, a resident's length of survival is not significantly influenced by the regulatory status of the facility in which he or she lived at baseline. However, residents with poor quality ratings at baseline had shorter survival times than those provided with good care. Median survival was 28 months among residents classified as receiving inadequate care compared to 41 months for those adequately cared for (p = 0.0217).
  
  
  CONCLUSIONS
  The study suggests that quality of care has a much stronger influence on resident outcomes than regulation per se. This finding underscores the relevance of testing innovative interventions aimed at improving the quality of care provided in long-term care facilities, regardless of their regulatory status.
authors.affiliation: Research Centre on Aging, Sherbrooke University Geriatric Institute, Quebec, Canada.
authors.forename: Gina
authors.initials: G
authors.lastname: Bravo
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Dubois
authors.forename: Philippe
authors.initials: P
authors.lastname: De Wals
authors.forename: Réjean
authors.initials: R
authors.lastname: Hébert
authors.forename: Lise
authors.initials: L
authors.lastname: Messier
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005161:Facility Regulation and Control / Q000331:legislation & jurisprudence*; D005260:Female; D006302:Health Services Research; D006801:Humans; D008134:Long-Term Care / Q000331:legislation & jurisprudence / Q000592:standards* / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D009026:Mortality / Q000639:trends*; D009735:Nursing Homes / Q000331:legislation & jurisprudence* / Q000592:standards* / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D011792:Quebec / Q000453:epidemiology; D016019:Survival Analysis