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 Researchers Hail New Metric for Measuring Nursing Home Supervision of Doctors

A team of researchers believe they’ve come up with a way to measure how tightly nursing homes supervise their doctors—which the researchers say could lead to better outcomes for residents.

Orna Intrator, Julie Lima, and Terrie Fox Wetle surveyed some 2,122 administrators in freestanding nursing homes between 2009 and 2011. They asked administrators about how they hired and supervised doctors (full-time or contract? Credentialed or no? How many times do medical directors check in on primary physicians?) and called their new proposed measure, “Nursing Home Control of Physician Resources.”

The metric was defined by a combination of three broad notions: credentialing, formal attachment to a nursing home, and oversight of the doctors, Intrator writes for her colleagues in the latest issue of the Journal of the American Medical Directors Association.

When researchers tested the new control yardstick against their hypothesis that rural, smaller homes would have less control over their doctors than urban, larger homes, the team found a nice correlation, Intrator says.

The average home with “weak” controls had about 96 beds, fewer Medicare or Medicaid patients, and a “slightly lower case mix.” They were also more likely to be in rural areas with fewer doctors per capita and lower occupancy rates and were less likely to have a doctor onsite at all times, Intrator writes.

Homes with “tight” controls over the doctors averaged about 119 beds; were more likely to be in urban areas with higher levels of doctors per capita; and had higher acuity, higher mix of publicly supported residents, and higher occupancy rates, Intrator says.

“These measures may relate to better care,” Intrator writes. “This finding may be important to the American Health Care Association and other associations to assist in targeting interventions to their for-profit members.”

David Gifford, an MD who also heads up AHCA’s quality initiatives, says he’s taking a close look at the researchers’ findings.

“We take these studies seriously,” he says. “And if the evidence supports more emphasis on credentialing, then we will certainly look to fold that into our best practices training. We have found, however, that an effective tool has been the QA evaluation methods currently in place where our centers seek a firsthand evaluation on the practices of our physicians.”

Intrator and her colleagues acknowledge that their work is only a first step. But they suspect that their proposed physician-control metric may show “a relationship” between nursing home “processes of care, and potentially hints at a possible association with … quality of care and resident outcomes,” Intrator says.

“Future studies,” Intrator suggests, “should examine the impact of tighter control of physician resources on resident outcomes such as fewer ‘bad medications,’ fewer hospitalizations, better end-of-life care, and other quality measures and resident outcomes.”

(Bill Myers is Provider's senior editor. E-mail him at Follow him on Twitter, @ProviderMyers.)


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