Maughan Matthew P, Yu Jiani, Jung Hye-Young
Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
J Am Med Dir Assoc. 2025 Jan;26(1):105364. doi: 10.1016/j.jamda.2024.105364. Epub 2024 Nov 18.
To analyze patient and facility characteristics associated with smaller versus larger nursing home (NH) chains.
This study used a cross-sectional study design.
NHs affiliated with multi-facility chains in the United States.
Using nationally representative data from LTCFocus 2021 Facility-Level File and the June 2023 Centers for Medicare and Medicaid Services (CMS) Affiliated Entity Performance Measures, we assessed differences in facility and patient characteristics among categories of NH chains size based on the number of certified beds (smallest to largest quintile of NH chain size) using one-way analysis of variance testing. We conducted linear regression analyses to examine the association between the quintile of chain size and staffing outcomes.
Among the 9348 NHs associated with 610 chains in our sample, the smallest quintiles of NH chains had the lowest percentage of for-profit facilities, a higher percentage of patients with Alzheimer's and dementia-related diseases, and higher percentages of long-stay residents needing assistance with activities of daily living (ADLs). The largest chain quintile was associated with fewer staffing hours per resident day (HPRD) for all total nurse staff -0.69 (95% CI, -0.86 to -0.52; P < .001), registered nurses (-0.25 HPRD; 95% CI, -0.32 to -0.17; P < .001), certified nursing assistants (CNAs) (-0.37 HPRD; 95% CI, -0.48 to -0.26; P < .001), and weekend total nurse staff (-0.57 HPRD; 95% CI, -0.71 to -0.42; P < .001]). The CMS staffing rating was also lower in larger NH chains (-0.73 for quintile 5; 95% CI, -0.98 to -0.48; P < .001).
Larger NH chains tended to treat less clinically complex patients and were associated with lower staffing ratios. Given increased attention and stricter rules regarding staffing by government agencies, increased monitoring of staffing in NHs affiliated with large chains by policymakers, antitrust agencies, and regulators is warranted.
分析与规模较小和较大的养老院连锁机构相关的患者及机构特征。
本研究采用横断面研究设计。
美国多机构连锁附属的养老院。
利用来自2021年长期护理聚焦设施层面文件的全国代表性数据以及2023年6月医疗保险和医疗补助服务中心（CMS）附属实体绩效指标，我们使用单因素方差分析，根据认证床位数量（养老院连锁规模从最小到最大的五分位数）评估不同规模养老院连锁类别之间的机构和患者特征差异。我们进行线性回归分析，以检验连锁规模五分位数与人员配备结果之间的关联。
在我们样本中与610个连锁机构相关的9348家养老院中，规模最小的五分位数养老院中营利性机构的比例最低，患有阿尔茨海默病和痴呆相关疾病的患者比例较高，以及需要日常生活活动（ADL）协助的长期居住居民比例较高。最大的连锁五分位数与所有护士总人员的每位居民每日工作时长（HPRD）较少相关——-0.69（95%CI，-0.86至-0.52；P<.001），注册护士（-0.25HPRD；95%CI，-0.32至-0.17；P<.001），认证护理助理（CNA）（-0.37HPRD；95%CI，-0.48至-0.26；P<.001），以及周末护士总人员（-0.57HPRD；95%CI，-0.71至-0.42；P<.001）。较大规模养老院连锁机构的CMS人员配备评级也较低（五分位数5为-0.73；95%CI，-0.98至-0.48；P<.001）。
较大规模的养老院连锁机构倾向于治疗临床复杂性较低的患者，且与较低的人员配备比率相关。鉴于政府机构对人员配备的关注度增加且规则更严格，政策制定者、反垄断机构和监管机构有必要加强对大型连锁附属养老院人员配备的监管。
