Doctor of Public Administration
Public Policy & Administration
Robert B. Oliver
Because of increasing costs and demand for nursing home care, studies are needed that can better describe the population of users and improve prediction of clinical outcomes and program requirements. The major purpose of this study was to explore the incremental and seven month outcomes of nursing home patients using the Andersen model. The design was longitudinal. Patients from one Veterans Administration (VA) hospital-based nursing home and six freestanding. VA contract community nursing homes were studied. Functional and cognitive ability were analyzed along with socioeconomic and demographic data. and utilization patterns.
A second purpose was to assess associations among variables and their interaction effects in predicting outcome. A third purpose was to assess the contribution of such independent variables as case-mix and rehospitalization rates to possible cost differences evidenced by the two nursing home types. The results of this study suggest avenues for planning and allocation of resources in the two program alternatives.
The Barthel Index (BI) (Mahoney & Barthel. 1965) was used to measure functional status and the Short Portable Mental Status Questionnaire (SPMSQ) (Pfeiffer. 1975) for cognitive ability. In addition to standardized measures. sociodemographic and utilization data. perceptions of health and outcomes of care were collected on all subjects.
Analytical techniques included descriptive and inferential statistics. The major hypothesis was that veterans in the hospital-based versus contract statistically signiﬁcant differences in characteristics and on measures of service use and clinical outcome. Findings were evaluated for policy adequacy. adherence to program intent. federal and state cost complement and other qualitative implications.
Statistically signiﬁcant differences were found between patients in the two settings on predisposing, enabling and need characteristics. The hospital-based NHCU patients were more likely to be married and living with someone. They also had higher incomes, more Medicare A coverage, a greater percentage of service-connected veterans and demonstrated greater limitation in functional ability than did those in contract.
The predominant outcome for both groups was continued nursing home care. Statistically signiﬁcant differences were also found for outcome measures. Higher income and being 76 years or older were predictive of continued nursing home residence. The type of nursing home was not signiﬁcant in explaining continued care. The total number of diagnoses. age group and type of nursing home were predictive of death as an outcome. There were signiﬁcantly more deaths among those 75 years or younger. among those with lower incomes and among NHCU patients.
Health service utilization did not differ signiﬁcantly by nursing home type. Neither group of nursing home patients demonstrated any signiﬁcant improvement in functional or mental status and self-perceived health. The only differences of note were among those 75 years or less who did improve in functional ability from the third to the sixth month.
The ﬁndings suggest that the two nursing home types do have different patient population proﬁles. However. the continued use of nursing home care by both groups indicates some lack of ﬁt between legislative intent and actual clinical utilization.
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