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APHA Scientific Session and Event Listing
2047.0: Sunday, November 04, 2007 - Board 8

Abstract #159696

Does quality of care matter in choosing a nursing home? Evidence from California

Irena Pesis-Katz, ABD, Community and Preventive Medicine, University of Rochester, 601 Elmwood Ave., Box 644, Rochester, NY 14642, 585-275-0165, irena_pesis-katz@urmc.rochester.edu, Charles E. Phelps, PhD, Office of the Provost, University of Rochester, 200 Wallis Hall, Rochester, NY 14627, Helena Temkin-Greener, PhD, Department of Community and Preventive Medicine, School of Medicine, University of Rochester, Box 644, 601 Elmwood Avenue, Rochester, NY 14642, William D. Spector, PhD, Agency for Healthcare Research & Quality, 540 Gaither Road, Room 5125, Rockville, MD 20850, Peter Veazie, PhD, Community & Preventive Medicine, University of Rochester, 601 Elmwood Avenue, Box 644, Rochester, NY 14642, and Dana B. Mukamel, PhD, Department of Medicine, Center for Health Policy Research, University of California, Irvine, 111 Academy, Suite 220, Irvine, CA 92697.

In choosing a nursing home (NH) consumers evaluate several quality of care dimensions. Some dimensions, such as hotel services, are observable, while clinical quality is mostly unobservable. We hypothesize that NH choice will be driven by observed rather than unobserved quality.

We examine nursing home choices in a period prior to publication of the federal NH Compare report card, i.e. when clinical quality was unobservable. We estimate the impact of facility and individual characteristics on consumers' choice, and assess the independent role of observable and unobservable quality. Observable quality is measured by hotel service-related deficiencies. Unobservable quality includes CMS clinical quality measures (QMs): decline in function, infections, pressure ulcers, physical restrains. MDS, OSCAR, NH cost reports and census data are used. The analytical sample includes 22,987 long-term care NH admissions in 2001 in California.

We find that Private pay consumers are much less likely to choose NHs with lower hotel quality (OR=0.83, p<0.01), than lower clinical quality (some QMs had no significant association with the choice and those with a significant association had odds ratios much closer to 1. Consumers' choice was also significantly (p=0.01) associated with: distance (OR=0.007); for-profit status (OR=0.87); and size (OR=1.27). Compared to private-pay, Medicaid consumers have a very limited NH choice.

Our findings suggest that in the absence of report cards, NH choice depends mostly on observable rather than clinical quality. Report cards can play an important role by revealing previously unobserved quality and potentially increasing the sensitivity of demand to clinical quality as well.

Learning Objectives:

Keywords: Nursing Homes, Quality of Care

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Long-Term Care Issues and Innovation

The 135th APHA Annual Meeting & Exposition (November 3-7, 2007) of APHA