Nursing home care is governed by institutional, state, and federal level policies. Despite the myriad number of policies and complex federal, state, and local enforcement system, there continues to be evidence of poor quality of care in some nursing homes in the United States. This study examined the relationship between selected state level health care policies in Washington, Idaho, and Oregon and quality measures derived from the nursing home minimum data set (MDS). The concept of quality was examined using King’s social, interpersonal and personal systems framework. A descriptive policy framework was developed using public access data sources for three state policies; Medicaid funding formulas, frequency and rigor of state nursing home surveys, and mandatory professional nurse staffing levels. Two archival data sets were chosen to define the variables of interest. The Provider of Service (POS) data contains the facility variables; size of facility, profit/nonprofit status, and rural/urban status of facilities. The Geriatric Minimum Data Set (MDS) contains resident data and was used to define resident age, gender, and acuity and the four outcome variables; pressure sore prevalence, prevalence of infections, greater than nine medications, and decline in late loss activities of daily living (ADLs). All nursing home residents excluding residents under sixty five years of age and those funded by Medicare for acute rehab in Washington, Idaho, and Oregon, in the year 2002 were included in the study. A statistical model was developed to examine the interaction between variables. However, further delineation of selected variables is necessary before use of this model. Preliminary descriptive examination of the variables delineated revealed Washington state had two of the three state policies most likely to support quality, yet three of the four resident outcomes indicated the poorest quality of care when comparing across the three states. Although some of the variables are not yet definitive for comparison, the preliminary results indicate compelling patterns worthy of further exploration.
Session #1223 - Graduate Student Poster Session
The 29th Annual MNRS Research Conference (April 1-4, 2005)