Nursing homes can achieve high quality while gaining cost efficiency, researchers find

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Nursing homes in the United States are generally efficient and able to control expenses without sacrificing quality of care, according to a recently released study in the Healthcare Management Review.

Researchers from Central Michigan University and Virginia Commonwealth University looked at a wide range of data for 1,430 nursing homes with between 20 and 360 beds. The number of full-time staff, facility beds and residents on Medicare, Medicaid and other forms of payment were considered to calculate efficiency. Quality of care measures included prevalence of pressure sores, use of physical restraints and residents with documented signs of depression.

Out of a perfect efficiency score of 1, the average score for nursing homes was 0.869. Not-for-profit and government facilities had higher average scores. The average score also rose for nursing homes in urban areas and in counties with greater competition among providers.

Of all the quality indicators studied, efficient nursing homes outperformed or were even with inefficient homes in every category except bladder incontinence. This may be because bladder incontinence is not very responsive to facility interventions, the researchers noted.

The study authors said the results do support public policy that sets “standards that encourage striving for both quality and efficiency simultaneously.” However, they cautioned the study “does not allow causal conclusions.”

“On the basis of a cross-sectional study, it is impossible to say whether higher quality is a result of a facility's effort to improve efficiency or whether higher efficiency resulted from quality improvement efforts,” the authors wrote.

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