SPECIALIZATION OF NURSING HOME CARE AND OUTCOMES1

Ajith Silva and Frank W. Porell

Review of Policy Research, 2000, vol. 17, issue 4, 111-152

Abstract: Implications of nursing home specialization for health outcomes were examined. The formal hypothesis tested in this study was that facilities specializing in the treatment of certain kinds of residents, as reflected in a critical mass of such residents, are more likely to experience better health outcomes over time compared to facilities that do not specialize in the treatment of such residents. Activities of Daily Living (ADLs), survival, and several diagnosis‐specific outcomes were analyzed for residents. Multivariate state‐dependence and logistic regression models were estimated for residents of six diagnostic sub‐groups. Specialization was empirically defined in terms of concentration of residents with certain diagnoses within nursing facilities. Empirical results indicate that specialization has some positive effects on some outcomes. For instance, facilities specializing in the care of Alzheimer's disease patients appear to produce comparatively better outcomes with respect to restraint use and accidents. Residents with diagnoses of hypertension or ischemic heart disease in specialized facilities also fare better in terms of survival. Residents with a diagnosis of cerebrovascular disease in specialized facilities were found to experience worse outcomes with respect to most of the outcomes modeled in this study, however. Overall, specialization only appears to make a difference in the outcomes of residents with certain medical conditions for some health outcomes. Regression results also indicate that basic measures of frailty such as functional deficiencies, incontinence, and behavioral problems largely contribute to detrimental effects irrespective of the diagnostic group or the outcome considered.

Date: 2000
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