title: Quality of care in for-profit and not-for-profit nursing homes: systematic review and meta-analysis.
abstract: OBJECTIVE
  To compare quality of care in for-profit and not-for-profit nursing homes.
  
  
  METHODS
  Systematic review and meta-analysis of observational studies and randomised controlled trials investigating quality of care in for-profit versus not-for-profit nursing homes.
  
  
  RESULTS
  A comprehensive search yielded 8827 citations, of which 956 were judged appropriate for full text review. Study characteristics and results of 82 articles that met inclusion criteria were summarised, and results for the four most frequently reported quality measures were pooled. Included studies reported results dating from 1965 to 2003. In 40 studies, all statistically significant comparisons (P<0.05) favoured not-for-profit facilities; in three studies, all statistically significant comparisons favoured for-profit facilities, and the remaining studies had less consistent findings. Meta-analyses suggested that not-for-profit facilities delivered higher quality care than did for-profit facilities for two of the four most frequently reported quality measures: more or higher quality staffing (ratio of effect 1.11, 95% confidence interval 1.07 to 1.14, P<0.001) and lower pressure ulcer prevalence (odds ratio 0.91, 95% confidence interval 0.83 to 0.98, P=0.02). Non-significant results favouring not-for-profit homes were found for the two other most frequently used measures: physical restraint use (odds ratio 0.93, 0.82 to 1.05, P=0.25) and fewer deficiencies in governmental regulatory assessments (ratio of effect 0.90, 0.78 to 1.04, P=0.17).
  
  
  CONCLUSIONS
  This systematic review and meta-analysis of the evidence suggests that, on average, not-for-profit nursing homes deliver higher quality care than do for-profit nursing homes. Many factors may, however, influence this relation in the case of individual institutions.
authors: Department of Medicine, University of British Columbia, Vancouver, BC, Canada V5Z 1M9.
authors: Vikram R
authors: VR
authors: Comondore
authors: P J
authors: PJ
authors: Devereaux
authors: Qi
authors: Q
authors: Zhou
authors: Samuel B
authors: SB
authors: Stone
authors: Jason W
authors: JW
authors: Busse
authors: Nikila C
authors: NC
authors: Ravindran
authors: Karen E
authors: KE
authors: Burns
authors: Ted
authors: T
authors: Haines
authors: Bernadette
authors: B
authors: Stringer
authors: Deborah J
authors: DJ
authors: Cook
authors: Stephen D
authors: SD
authors: Walter
authors: Terrence
authors: T
authors: Sullivan
authors: Otavio
authors: O
authors: Berwanger
authors: Mohit
authors: M
authors: Bhandari
authors: Sarfaraz
authors: S
authors: Banglawala
authors: John N
authors: JN
authors: Lavis
authors: Brad
authors: B
authors: Petrisor
authors: Holger
authors: H
authors: Schünemann
authors: Katie
authors: K
authors: Walsh
authors: Neera
authors: N
authors: Bhatnagar
authors: Gordon H
authors: GH
authors: Guyatt
mesh_terms: D000368:Aged; D006707:Homes for the Aged / Q000191:economics / Q000592:standards*; D006801:Humans; D009735:Nursing Homes / Q000191:economics / Q000592:standards*; D009939:Organizations, Nonprofit / Q000592:standards*; D017063:Outcome Assessment, Health Care; D003668:Pressure Ulcer / Q000209:etiology / Q000517:prevention & control; D017149:Private Sector / Q000191:economics / Q000592:standards*; D017150:Public Sector / Q000191:economics / Q000592:standards*; D011787:Quality of Health Care; D012149:Restraint, Physical / Q000706:statistics & numerical data; D000078329:Workforce