Zinn J S, Mor V, Castle N, Intrator O, Brannon D
Department of Health Administration, School of Business and Management, Temple University, Philadelphia, PA 19122, USA.
Health Serv Res. 1999 Feb;33(6):1753-67.
To develop and test a model, based on resource dependence theory, that identifies the organizational and environmental characteristics associated with nursing home participation in managed care.
Data for statistical analysis derived from a survey of Directors of Nursing in a sample of nursing homes in eight states (n = 308). These data were merged with data from the On-line Survey Certification and Reporting System, the Medicare Managed Care State/County Data File, and the 1995 Area Resource File.
Since the dependent variable is dichotomous, the logistic procedure was used to fit the regression. The analysis was weighted using SUDAAN.
Participation in a provider network, higher proportions of resident care covered by Medicare, providing IV therapy, greater availability of RNs and physical therapists, and Medicare HMO market penetration are associated with a greater likelihood of having a managed care contract.
As more Medicare recipients enroll in HMOs, nursing home involvement in managed care is likely to increase. Interorganizational linkages enhance the likelihood of managed care participation. Nursing homes interested in managed care should consider upgrading staffing and providing at least some subacute services.
基于资源依赖理论开发并测试一个模型，该模型可识别与疗养院参与管理式医疗相关的组织和环境特征。
用于统计分析的数据来自对八个州的一组疗养院（n = 308）的护理主任进行的调查。这些数据与在线调查认证和报告系统、医疗保险管理式医疗州/县数据文件以及1995年区域资源文件中的数据合并。
由于因变量是二分变量，因此使用逻辑回归程序来拟合回归模型。分析使用SUDAAN进行加权。
参与供应商网络、医疗保险覆盖的居民护理比例更高、提供静脉治疗、注册护士和物理治疗师的可获得性更高以及医疗保险健康维护组织（HMO）的市场渗透率与签订管理式医疗合同的可能性更大相关。
随着越来越多的医疗保险受益人加入健康维护组织，疗养院参与管理式医疗的情况可能会增加。组织间联系增加了参与管理式医疗的可能性。对管理式医疗感兴趣的疗养院应考虑提升人员配备并至少提供一些亚急性服务。
