Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Am Geriatr Soc. 2024 Oct;72(10):3078-3088. doi: 10.1111/jgs.19104. Epub 2024 Jul 29.
Efforts to increase transparency and accountability of nursing homes, and thus improve quality, now include information about changes in nursing home ownership. However, little is known about how change in ownership affects nursing home quality.
We conducted a retrospective cohort study of 15,471 U.S. nursing homes between January 2016 and December 2022, identifying all changes in ownership during that period. We used logistic regression to measure the association between nursing home characteristics and the odds of a change in ownership. A difference-in-differences model with multiple time periods was used to examine the impact of a change in ownership on the Medicare Nursing Home Compare 5-star ratings.
One in five (23%) facilities changed ownership between 2016 and 2022. Nursing homes that were urban, for-profit, part of a chain, located in the South, had >50 beds, lower occupancy, higher percentage of stays covered by Medicaid, higher percentage of residents with non-white race, or a 1-star (poor) rating were more likely to undergo a change in ownership. There was a small statistically significant decrease in 5-star ratings after a change in ownership (-0.09 points on a 5-point scale; 95% CI -0.13 to -0.04; p < 0.001), driven primarily by a decrease in staffing ratings (-0.19 points; 95% CI -0.24 to -0.14; p < 0.001), and health inspections ratings (-0.07 points; 95% CI -0.11 to -0.03; p = 0.001). This was mitigated by an increase in quality measure ratings (0.15 points; 95% CI 0.10-0.20; p < 0.001).
Nursing Home Compare ratings decreased slightly after a change in facility ownership, driven by lower staffing and health inspection ratings and mitigated somewhat by higher quality measure ratings. These conflicting trends underscore the need for transparency around changes in facility ownership and a better understanding of consequences of changes in ownership that are salient to patients and families.
为了提高养老院的透明度和问责制，从而提高服务质量，目前养老院的信息包括所有权变更的情况。然而，人们对所有权变更如何影响养老院的质量知之甚少。
我们对 2016 年 1 月至 2022 年 12 月期间的 15471 家美国养老院进行了回顾性队列研究，确定了在此期间所有的所有权变更情况。我们使用逻辑回归来衡量养老院特征与所有权变更概率之间的关联。使用具有多个时间段的差异中的差异模型来检查所有权变更对医疗保险养老院比较 5 星级评级的影响。
在 2016 年至 2022 年间，五分之一（23%）的设施发生了所有权变更。城市、营利性、连锁、位于南部、拥有 50 张以上床位、入住率较低、医疗保险覆盖率较高、居民非白人比例较高或评级为 1 星级（差）的养老院更有可能发生所有权变更。在所有权变更后，5 星级评级略有下降（5 分制下降 0.09 分；95%置信区间 -0.13 至 -0.04；p<0.001），主要是因为工作人员评分下降（-0.19 分；95%置信区间 -0.24 至 -0.14；p<0.001）和健康检查评分下降（-0.07 分；95%置信区间 -0.11 至 -0.03；p=0.001）。这一趋势被质量衡量指标评分的上升（0.15 分；95%置信区间 0.10-0.20；p<0.001）所缓解。
在设施所有权变更后，医疗保险养老院比较评级略有下降，这主要是由于工作人员和健康检查评分下降，而质量衡量指标评分的上升在一定程度上缓解了这一下降趋势。这些相互矛盾的趋势突出表明，需要对设施所有权变更进行透明化，并更好地理解对患者和家属具有重要意义的所有权变更的后果。
