养老院连锁规模和所有权状态会影响护理体验吗？
Do Nursing Home Chain Size and Proprietary Status Affect Experiences With Care?
作者信息
You Kai, Li Yue, Intrator Orna, Stevenson David, Hirth Richard, Grabowski David, Banaszak-Holl Jane
机构信息
*Department of Economics, University at Albany, State University of New York, Albany †Department of Public Health Sciences, Division of Health Policy and Outcomes Research, University of Rochester Medical Center, Rochester, NY ‡Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN §Department of Health Management and Policy, University of Michigan, Ann Arbor, MI ∥Department of Health Care Policy, Harvard Medical School, Boston, MA.
出版信息
Med Care. 2016 Mar;54(3):229-34. doi: 10.1097/MLR.0000000000000479.
BACKGROUND
In 2012, over half of nursing homes were operated by corporate chains. Facilities owned by the largest for-profit chains were reported to have lower quality of care. However, it is unknown how nursing home chain ownerships are related with experiences of care.
OBJECTIVES
To study the relationship between nursing home chain characteristics (chain size and profit status) with patients' family member reported ratings on experiences with care.
DATA SOURCES AND STUDY DESIGN
Maryland nursing home care experience reports, the Online Survey, Certification, And Reporting (OSCAR) files, and Area Resource Files are used. Our sample consists of all nongovernmental nursing homes in Maryland from 2007 to 2010. Consumer ratings were reported for: overall care; recommendation of the facility; staff performance; care provided; food and meals; physical environment; and autonomy and personal rights. We identified chain characteristics from OSCAR, and estimated multivariate random effect linear models to test the effects of chain ownership on care experience ratings.
RESULTS
Independent nonprofit nursing homes have the highest overall rating score of 8.9, followed by 8.6 for facilities in small nonprofit chains, and 8.5 for independent for-profit facilities. Facilities in small, medium, and large for-profit chains have even lower overall ratings of 8.2, 7.9, and 8.0, respectively. We find similar patterns of differences in terms of recommendation rate, and important areas such as staff communication and quality of care.
CONCLUSIONS
Evidence suggests that Maryland nursing homes affiliated with large-for-profit and medium-for-profit chains had lower ratings of family reported experience with care.
背景
2012年，超过半数的疗养院由连锁企业运营。据报道，最大的营利性连锁企业旗下的疗养院护理质量较低。然而，尚不清楚疗养院的连锁所有权与护理体验之间存在怎样的关联。
目的
研究疗养院连锁特征（连锁规模和营利状况）与患者家属报告的护理体验评分之间的关系。
数据来源与研究设计
使用了马里兰州疗养院护理体验报告、在线调查、认证及报告（OSCAR）文件以及区域资源文件。我们的样本包括2007年至2010年马里兰州所有的非政府疗养院。报告了消费者对以下方面的评分：整体护理；对疗养院的推荐；员工表现；提供的护理；食物和膳食；物理环境；自主权和个人权利。我们从OSCAR中确定连锁特征，并估计多元随机效应线性模型以检验连锁所有权对护理体验评分的影响。
结果
独立非营利性疗养院的总体评分最高，为8.9分，其次是小型非营利性连锁机构的疗养院，评分为8.6分，独立营利性机构的评分为8.5分。小型、中型和大型营利性连锁机构的疗养院总体评分甚至更低，分别为8.2分、7.9分和8.0分。我们在推荐率以及员工沟通和护理质量等重要方面发现了类似的差异模式。
结论
有证据表明，隶属于大型营利性和中型营利性连锁机构的马里兰州疗养院，其家属报告的护理体验评分较低。
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