Zhang X; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2002; 19: 15.
University of Alabama at Birmingham, WEBB Nutrition Sciences Bldg., Room 524, 1675 University Blvd, Birmingham, AL 35205; Tel: (205) 975-7376; Fax: (205) 975-6608; E-mail: zxz@uab.edu
RESEARCH OBJECTIVE: In 1987, Congress passed the Omnibus Budget Reconciliation Act (OBRA87) with the goal of improving the quality of care in nursing homes. OBRA87 mandated minimum-staffing standards and required a reduction in the use of unnecessary drugs, unnecessary physical restraints, and any significant medication errors. Since the implementation of OBRA87, serious questions have been raised about whether the federal regulations brought about a positive change in nursing homes. However, research findings in this field are limited and inconclusive. I examined nursing homes in 25 states with data from three years before, and three years after, the implementation of OBRA87 in order to answer the following questions: (1) What is the influence of OBRA87 regulations on nursing home staffing levels? (2) What is the influence of OBRA87 regulations on the quality of care in nursing homes? STUDY DESIGN: The panel sample of 5,626 nursing homes were drawn from the 1987 Medicare/Medicaid Automated Certification System (MMACS) and the 1993 Online Survey, Certification and Reporting (OSCAR) system containing home-level quality and other structural information from twenty five states nationwide. Nursing home staffing was measured by FTEs (full time equivalents) of registered nurses (RNs), licensed practical nurses (LPNs) and nurses' aides (NAs). Nursing home quality was measured by the proportion of nursing home residents with a bedsore, the proportion of residents with urinary catheters and the proportion of residents with physical restraints. I conducted multiple regression analyses to determine whether the implementation of OBRA87 improved nursing home staffing levels and furthermore, improved the quality of care in nursing homes. POPULATION STUDIED: Nursing homes. PRINCIPAL FINDINGS: From 1987 to 1993, nursing home staffing had a significant increase on RNs, LPNs, and NAs. Moreover, before and after the implementation of OBRA87, the proportion of residents with bedsores, physical restraints and urinary catheters decreased. Controlling for staffing, resident characteristics, facility characteristics, and market characteristics, the bedsore, physical restraint and urinary catheter measures all decreased from 1987 to 1993, especially the physical restraint and urinary catheter measures. Interestingly however, the increase in staffing was not related to the improvement in these other quality measures. CONCLUSIONS: Overall, there was a significant increase in nursing home staffing levels due to the OBRA87 minimum staffing standard. However, this increase may not necessarily have been associated with improved quality within nursing homes. Although some quality improvements were found in nursing homes nationwide, especially in the reduced use of physical restraints and urinary catheters, these improvements were primarily related to other provisions within OBRA87. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: My findings suggest that the OBRA87 regulations have had some positive effects on the quality of nursing home care. However, these improvements have been largely due to increased oversight rather than higher staffing levels.
Publication Types:
Keywords:
- Budgets
- Certification
- Data Collection
- Medicaid
- Medicare
- Medication Errors
- Nursing Homes
- Nursing Staff
- Regression Analysis
- Restraint, Physical
- economics
- hsrmtgs
Other ID:
UI: 102274175
From Meeting Abstracts