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Nursing Home Quality in New York State by Patricia Loubeau

ZEW Long-Term-Care Conference Mannheim, 2005. Nursing Home Quality in New York State by Patricia Loubeau. Discussion by Kristin J. Kleinjans, University of Aarhus and RAND. Summary – Objective of Study.  to better understand what influences quality of care, specifically influence of

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Nursing Home Quality in New York State by Patricia Loubeau

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  1. ZEW Long-Term-Care Conference Mannheim, 2005 Nursing Home Quality in New York Stateby Patricia Loubeau Discussion by Kristin J. Kleinjans, University of Aarhus and RAND

  2. Summary – Objective of Study  to better understand what influences quality of care, specifically influence of • staff hours • ownership (profit vs. nonprofit) • chain membership • bed size • (area) competition

  3. Summary – Data and Variables • Data from 7 counties in New York State • big sample: 184 nursing homes (1/3 of beds) • 3 measures of quality: • Facility rating by state department of health • # of state health code deficiencies • Composite level of harm

  4. Summary - Results •  no quality differences based on • staffing (results only for state health code standards) • ownership/ chain membership (measures?) • size (measure?) •  lower quality with higher competition (all 3 measures)

  5. Summary – Data Shortcomings • No data on health status of residentsquality measure means different things for different types of health problems (Ex.: staffing) • No data on cost of individual nursing homerelation between quality and cost cannot be investigated • Not generalizablevery different ownership and quality in NY state

  6. Comments • Interesting and important subject • Comparable data, big sample • Interesting conclusions, discussion of institutions and possible interpretations

  7. Comments: Methods • Unclear methods: From what are conclusions derived? Tables with coefficients, st errors, etc. needed • by dependent variable ordered logit/ probit with covariates Xi as regressorsReport results of sensitivity analysis & specification tests

  8. Comments: Outcome Measures • Explanation of quality measures needed: What are the exact deficiencies? (Table) • Not all deficiencies equally important & might confound results e.g., # of state health deficiencies incl. personnel policies (potential for reversal causation – staffing measure) • (Seem to) only concern health care quality≠ quality (surroundings, social/ mental care,…) also excludes outside provision of services (such as hospice care)

  9. Comments: Prices • Missing prices can explain some of the results product differentiation: cheap and low quality vs. expensive and high quality • Ex.: New York City; cost betw. $220 & $423 per day •  individual choose according to preferences  higher quality not (always) better • Problem: no price information in data maybe something to proxy? (room size, facilities, average income of zipcode)

  10. Comment: Lack of Info on Health Status •  Results are more interesting if health status of residents is known (otherwise, meaning of coefficients is unclear) • Omitted variable bias if correlated with independent variables, e. g. staffing, size • not in data, but maybe a proxy to be used as IV? • Some potential candidates: • ratio of personnel at night/day facilities (types of beds, … )

  11. Minor Comments • Table 2 needs units, min and max, explanation of variables (especially categories of quality measures) • Table 3: source • Table 4: sums do not all sum up to 100% (even with rounding) • Table 5: Misleading title, comparison of average deficiencies in sample, state, and US as a whole

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