title: Organizational and environmental correlates of the adoption of a focus strategy in U.S. hospices.
abstract: BACKGROUND
  The hospice industry has experienced rapid growth in the last decade and has become a prominent component of the U.S. health care delivery system. In recent decades, the number of hospices serving nursing facility residents has increased. However, there is paucity of research on the organizational and environmental determinants of this strategic behavior.
  
  
  OBJECTIVE
  The aim of this study was to empirically identify the factors associated with the adoption of a nursing facility focus strategy in U.S. hospices. A nursing facility focus strategy was defined in this study as a strategic choice to target the provision of hospice services to skilled nursing facility or nursing home residents.
  
  
  METHODS
  This study employed a longitudinal study design with lagged independent variables in answering its research questions. Data for the study's dependent variables are obtained for the years 2005-2008, whereas data for the independent variables are obtained for the years 2004-2007, representing a 1-year lag. Mixed effects regression models were used in the multivariate regression analyses.
  
  
  RESULTS
  Using a resource dependence framework, the findings from this study indicate that organizational size, community wealth, competition, and ownership type are important predictors of the adoption of a nursing facility focus strategy.
  
  
  CONCLUSIONS
  Hospices may be adopting a nursing facility focus strategy in response to increasing competition. The decision to focus the provision of care to nursing facility residents may be driven by the need to secure stability in referrals. Further empirical exploration of the performance implications of adopting a nursing facility focus strategy is warranted.
authors.affiliation: Bettye A. Apenteng, PhD, is Assistant Professor, Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro. E-mail: bapenteng@georgiasouthern.edu. Preethy Nayar, MD, PhD, MPhil, is Associate Professor, Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha. Fang Yu, PhD, is Associate Professor, Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha. John Adams, PhD, MBA, MA, is Associate Professor, Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha. Samuel T. Opoku, MBChB, is Doctoral Student, Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha.
authors.forename: Bettye A
authors.initials: BA
authors.lastname: Apenteng
authors.forename: Preethy
authors.initials: P
authors.lastname: Nayar
authors.forename: Fang
authors.initials: F
authors.lastname: Yu
authors.forename: John
authors.initials: J
authors.lastname: Adams
authors.forename: Samuel T
authors.initials: ST
authors.lastname: Opoku
mesh_terms: D006276:Health Facility Size / Q000458:organization & administration / Q000706:statistics & numerical data; D006738:Hospices / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D017146:Models, Organizational; D010067:Ownership / Q000458:organization & administration / Q000706:statistics & numerical data; D012866:Skilled Nursing Facilities / Q000458:organization & administration / Q000706:statistics & numerical data; D014481:United States