slide1
Download
Skip this Video
Download Presentation
Christopher M. Kelly, Phoebe S. Liebig, and Lloyd J. Edwards SAMSI Transition Workshop

Loading in 2 Seconds...

play fullscreen
1 / 15

Christopher M. Kelly, Phoebe S. Liebig, and Lloyd J. Edwards SAMSI Transition Workshop - PowerPoint PPT Presentation


  • 61 Views
  • Uploaded on

Determinants of Nursing Home Regulatory Activity in the 50 States: An Analysis from the Political Economy Perspective. Christopher M. Kelly, Phoebe S. Liebig, and Lloyd J. Edwards SAMSI Transition Workshop November 10, 2005. Acknowledgments.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Christopher M. Kelly, Phoebe S. Liebig, and Lloyd J. Edwards SAMSI Transition Workshop' - lani-atkinson


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

Determinants of Nursing Home Regulatory Activity in the 50 States: An Analysis from the Political Economy Perspective

Christopher M. Kelly, Phoebe S. Liebig, and Lloyd J. Edwards

SAMSI Transition Workshop

November 10, 2005

acknowledgments
Acknowledgments
  • Dr. Kelly was supported in part by a postdoctoral fellowship1 in the Carolina Program in Health and Aging Research (CPHAR) at the University of North Carolina at Chapel Hill

1Grant ST32AG00272 from the National Institute on Aging

nursing home regulation in the united states
Nursing Home Regulation in the United States
  • Under OBRA 87, states survey nursing homes, CMS oversees
  • State surveyors rate nursing home deficiencies according to scope and severity
  • Information is available to consumers on CMS’s Nursing Home Compare website
research questions
Research Questions
  • What is the extent of nursing home regulatory activity in the 50 states?
  • How did extent change over a three-year period?
  • What factors predict citation volume & severity in the 50 states?
political economy perspective
Political Economy Perspective

Age

Race

State

Citizen/Public

Sex/Gender Capital

Class

Ideology

Estes (2001)

linear mixed model
Linear Mixed Model
  • Used to identify predictors of the volume and severity of state citations
  • Provides estimation and hypothesis testing for modeling population and random effects
  • Can accommodate data missing completely at random
linear mixed model is useful for studying state regulatory activity
Linear Mixed Model is Useful for Studying State Regulatory Activity
  • Longitudinal data (i.e. nursing home quality over several years)
  • Population data - 50 U.S. states.

Large sample techniques are challenged.

  • Parsimonious model needed (N =50)
  • Random intercept and slope.
  • Within-subject errors assumed i.i.d.
nursing home deficiencies stable but less severe
Nursing Home Deficiencies Stable, but Less Severe
  • Number of deficiencies has remained level (about 6 per nursing home)
  • Percentage of severe deficiencies has declined (about 7% of all deficiencies cause actual harm)
  • States vary widely in volume & severity of deficiency citations
possible predictors of the extent of state regulatory activity
External Determinants

Urbanization

Education

Age

Political Culture

Internal Determinants

Nursing Home

State Surveying Agency

Legislature

Interest Groups

Governor

Possible Predictors of the Extent of State Regulatory Activity
future use of the linear mixed model
Future Use of the Linear Mixed Model
  • Repetitive Scheduling of Annual Inspections: States are to avoid inspecting a nursing home during the same month in consecutive years
  • Deficiency Resolution: States are to resolve non-actual harm deficiencies within 60 days and actual harm deficiencies within 30 days
contact information
Contact Information

Christopher M. Kelly, Ph.D.

CPHAR Post Doctoral Fellow

Institute on Aging

University of North Carolina at Chapel Hill

Tel 919 843 8065

[email protected]

ad