Defense Date


Document Type


Degree Name

Doctor of Philosophy


Health Administration

First Advisor

Jan Clement

Second Advisor

Cathy Bradley

Third Advisor

Gloria Bazzoli

Fourth Advisor

David Harless


Cancer is the second leading cause of death in the U.S and is more common among the elderly. Since frailty and other age related conditions put the elderly at risk for nursing home care, nursing homes may be the site of care and death for many elderly cancer patients. However, there is a large gap in knowledge concerning cancer treatment of elderly nursing home residents. Since residents rely heavily on their nursing facilities, nursing homes might influence them in their treatment decisions. After controlling for resident and nursing home market characteristics, this study applies Andersen’s Behavioral Model to examine whether nursing home organizational characteristics (nurse staffing level, nursing skill mix, and quality deficiencies) are related to the use of cancer-related medical services for treatment (oncologist visits, cancer-directed surgery, chemotherapy or radiation therapy), and palliative care (pain medication and hospice services) among 1,183 Medicaid and Medicare insured residents of nursing homes in Michigan from 1996-2000. Using data from the Medicare claim file, Medicaid claim file, Michigan tumor registry, Area Resource File, Michigan Medicaid Nursing Home Cost Report, and Online Survey, Certification and Reporting (OSCAR), the study used logistic regression to predict the utilization of cancer-related medical services. The results generally did not support the hypotheses. Nursing staffing level and nursing skill mix did not predict any cancer-related medical service utilization. Cancer care may be more associated with patient characteristics, such as age, which are usually taken into consideration when physicians suggest treatments, than nursing home organizational characteristics. However, relative to residents of nursing homes with the highest quartile of quality deficiencies, residents of nursing homes in the lowest quartile of quality deficiencies had a decreased likelihood of utilizing hospice care (OR=.509; 95%CI=.325 to .796; p=.003). Residents in high quality nursing homes may want to stay in the same place and not transfer to another facility for hospice care while residents in poor quality nursing homes may be motivated to use hospice care. Even though this study did not successfully find that higher nurse staffing level, nursing skill mix, quality of care are associated with greater opportunity of utilizing cancer-related medical services, this study was successful in laying out an empirically sound base framework to analyze this association. Future research can incorporate other states or nationwide data to re-examine this relationship using this study as a base model.


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