Doctor of Philosophy
Health Related Sciences
Thomas T. H. Wan
Objective: The primary objective of this research is to examine how changing levels of nursing home stafﬁng adequacy and variations in rehabilitation orientation have affected facility deﬁciencies and the quality of patient care as facilities responded to the Balanced Budget Act of 1997.
Data Sources: Analyses were performed using data from the On-Line Survey Certiﬁcation and Reporting System (OSCAR) data from years 1997, 1998, 1999, 2000 and 2001 and were merged with Area Resource File (ARF) data released in February 2001.
Study Design: Contingency strategic adaptation provides the theoretical framework for developing the effects of environmental characteristics, organizational characteristics and strategic change on nursing facilities’ performance. The study employed a non-experimental, longitudinal panel design focusing on the individual nursing home as the unit of analysis. Measurement models were proposed and validated for each of the research constructs. Structural equation modeling was used to specify the relationships between stafﬁng adequacy, rehabilitation orientation and nursing home quality.
Principal Findings: Decreases in stafﬁng adequacy and rehabilitation orientation, and also in nursing home quality occurred during the period of 1997 to 2001. Environmental and organizational characteristics have various direct effects on stafﬁng, rehabilitation orientation and nursing facility performance. Stafﬁng directly affects rehabilitation orientation; rehabilitation orientation directly affects quality. The variances accounted for in the ﬁnal structural model are small.
Conclusion: Stafﬁng and rehabilitation orientation are, respectively, structures and processes of care subject to strategic change within organizations in response to changing environmental conditions. Changes in stafﬁng and rehabilitation that occurred during the period of implementation of the BBA of 1997 reduced nursing facility performance. The relatively small contribution of each to the measurement of nursing facility performance suggests that other structures and processes should be identiﬁed, and their impact on the quality of care evaluated.
Keywords: Staffing, rehabilitation, nursing home deficiencies, strategic adaptation, Balanced Budget Act of 1997.
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