Quality of care in for-profit and not-for-profit nursing homes: systematic review and meta-analysis.
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.
Comondore
Vikram R
VR
Department of Medicine, University of British Columbia, Vancouver, BC, Canada V5Z 1M9.
Devereaux
P J
PJ
Zhou
Qi
Q
Stone
Samuel B
SB
Busse
Jason W
JW
Ravindran
Nikila C
NC
Burns
Karen E
KE
Haines
Ted
T
Stringer
Bernadette
B
Cook
Deborah J
DJ
Walter
Stephen D
SD
Sullivan
Terrence
T
Berwanger
Otavio
O
Bhandari
Mohit
M
Banglawala
Sarfaraz
S
Lavis
John N
JN
Petrisor
Brad
B
Schünemann
Holger
H
Walsh
Katie
K
Bhatnagar
Neera
N
Guyatt
Gordon H
GH
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