7 research outputs found
Persistent geographic variations in availability and quality of nursing home care in the United States:1996 to 2016
Abstract Background Availability of nursing home care has declined and national efforts have been initiated to improve the quality of nursing home care in the U.S. Yet, data are limited on whether there are geographic variations in declines of availability and quality of nursing home care, and whether variations persist over time. We sought to assess geographic variation in availability and quality of nursing home care. Methods Retrospective study using Medicaid/Medicare-certified nursing home data from the Centers for Medicare & Medicaid Services, 1996â2016. Outcomes were 1) availability of all nursing home care (1996â2016), measured by the number of Medicaid/Medicare-certified beds for a given county per 100,000 population aged â„65âyears, regardless of nursing home star rating; 2) availability of 5-star nursing home care, measured by the number of Medicaid/Medicare-certified beds provided by 5-star nursing homes; and 3) utilization of nursing home beds, defined as the rate of occupied Medicaid/Medicare-certified beds among the total Medicaid/Medicare-certified beds. Results From 1999 to 2016, availability of all nursing home care declined from 4882 (standard deviation: 931) to 3480 (912) beds, per 100,000 population aged â„65âyears. Persistent geographic variation in availability of nursing home care was observed; the correlation coefficient of county-specific availabilities from 1996 to 2016 was 0.78 (95% CI 0.77â0.79). From 2011 to 2016, availability of 5-star nursing home beds increased from 658 (303) to 895 (661) per 100,000 population aged â„65âyears. The correlation coefficient for county-specific availabilities from 2011 to 2016 was 0.54 (95% CI 0.51â0.56). Availability and quality of nursing home care were not highly correlated. In 2016, the correlation coefficient for county-specific availabilities between all nursing home and 5-star nursing home beds was 0.33 (95% CI 0.30â0.36). From 1996 to 2016, the utilization of certified beds declined from 78.5 to 72.2%. This decline was consistent across all census divisions, but most pronounced in the Mountain division and less in the South-Atlantic division. Conclusion We observed persistent geographic variations in availability and quality of nursing home care. Availability of all nursing home care declined but availability of 5-star nursing home care increased. Availability and quality of nursing home care were not highly correlated
Connecting the Dots for Democratic Accountability: Semantic Web-Based Information Sharing Policy and the Future of Investigative Reporting
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Association Between Hospital Performance on Patient Safety and 30âDay Mortality and Unplanned Readmission for Medicare FeeâforâService Patients With Acute Myocardial Infarction
Background: Little is known regarding the relationship between hospital performance on adverse event rates and hospital performance on 30âday mortality and unplanned readmission rates for Medicare feeâforâservice patients hospitalized for acute myocardial infarction (AMI). Methods and Results: Using 2009â2013 medical recordâabstracted patient safety data from the Agency for Healthcare Research and Quality's Medicare Patient Safety Monitoring System and hospital mortality and readmission data from the Centers for Medicare & Medicaid Services, we fitted a mixedâeffects model, adjusting for hospital characteristics, to evaluate whether hospital performance on patient safety, as measured by the hospitalâspecific riskâstandardized occurrence rate of 21 common adverse event measures for which patients were at risk, is associated with hospitalâspecific 30âday allâcause riskâstandardized mortality and unplanned readmission rates for Medicare patients with AMI. The unit of analysis was at the hospital level. The final sample included 793 acute care hospitals that treated 30 or more Medicare patients hospitalized for AMI and had 40 or more adverse events for which patients were at risk. The occurrence rate of adverse events for which patients were at risk was 3.8%. A 1% point change in the riskâstandardized occurrence rate of adverse events was associated with average changes in the same direction of 4.86% points (95% CI, 0.79â8.94) and 3.44% points (95% CI, 0.19â6.68) for the riskâstandardized mortality and unplanned readmission rates, respectively. Conclusions: For Medicare feeâforâservice patients discharged with AMI, hospitals with poorer patient safety performance were also more likely to have poorer performance on 30âday allâcause mortality and on unplanned readmissions