title: Nursing home control of physician resources.
abstract: OBJECTIVE
  Physician services are increasingly recognized as important contributors to quality care provision in nursing homes (NH)s, but knowledge of ways in which NHs manage/control physician resources is lacking.
  
  
  METHODS
  Primary data from surveys of NH administrators and directors of nursing from a nationally representative sample of 1938 freestanding United States NHs in 2009-2010 matched to Online Survey Certification and Reporting, aggregated NH Minimum Data Set assessments, Medicare claims, and county information from the Area Resource File.
  
  
  METHODS
  The concept of NH Control of Physician Resources (NHCOPR) was measured using NH administrators' reports of management implementation of rules, policies, and procedures aimed at coordinating work activities. The NHCOPR scale was based on measures of formal relationships, physician oversight and credentialing. Scale values ranged from weakest (0) to tightest (3) control. Several hypotheses of expected associations between NHCOPR and other measures of NH and market characteristics were tested.
  
  
  RESULTS
  The full NHCOPR score averaged 1.58 (standard deviation = 0.77) on the 0-3 scale. Nearly 30% of NHs had weak control (NHCOPR ≤1), 47.5% had average control (NHCOPR between 1 and 2), and the remaining 24.8% had tight control (NHCOPR >2). NHCOPR exhibited good face- and predictive-validity as exhibited by positive associations with more beds, more Medicare services, cross coverage, and number of physicians in the market.
  
  
  CONCLUSIONS
  The NHCOPR scale capturing NH's formal structure of control of physician resources can be useful in studying the impact of NH's physician resources on residents' outcomes with potential for targeted interventions by education and promotion of NH administration regarding physician staff.
authors: Department of Public Health Sciences, University of Rochester, Rochester, NY; Canandaigua Veterans' Administration Medical Center, Canandaigua, NY. Electronic address: Orna_Intrator@URMC.Rochester.Edu.
authors: Orna
authors: O
authors: Intrator
authors: Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, RI.
authors: Julie C
authors: JC
authors: Lima
authors: Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, RI.
authors: Terrie Fox
authors: TF
authors: Wetle
mesh_terms: D019538:Health Care Surveys; D006295:Health Resources / Q000458:organization & administration*; D006801:Humans; D009735:Nursing Homes / Q000458:organization & administration*; D058007:Physicians, Primary Care; D011787:Quality of Health Care
keywords: Nursing home physicians; care organization; control; management of medical staff