ArticleHealth services research2012
The effect of state regulatory stringency on nursing home quality.
Article in Health services research, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed.
- Lessons Learned From the Implementation of a Pragmatic Trial Evaluating Non-Pharmacological Approaches to Dementia Care in US Nursing Homes.Journal of evaluation in clinical practice · 2026Article
- Evaluating administrative compliance as a predictor of nursing home postdisaster outcomes in the USA.BMJ public health · 2026Article
- Penalties in 2024 in Medicare's Skilled Nursing Facility Value-Based Purchasing Program.Journal of the American Geriatrics Society · 2025Article
- Association of Nursing Home Exposure to Hurricane-Related Inundation With Emergency Preparedness.JAMA network open · 2023Article
- The Relationship Between States' Staffing Regulations And Hospitalizations Of Assisted Living Residents.Health affairs (Project Hope) · 2021Article
- Variability and Potential Determinants of Assisted Living State Regulatory Stringency.Journal of the American Medical Directors Association · 2021Observational
- Context, mechanisms and outcomes of dementia special care units: An initial programme theory based on realist methodology.PloS one · 2021Article
- Variation in Licensed Nurse Staffing Characteristics by State Requirements in Residential Care.Research in gerontological nursing · 2019Article
- Article
- Effects of Medicare Medical Reviews on Ambiguous Short-Stay Hospital Admissions.Health services research · 2018Observational
- Trends in treatment with antipsychotic medication in relation to national directives, in people with dementia - a review of the Swedish context.BMC psychiatry · 2017Article
- The Need for Higher Minimum Staffing Standards in U.S. Nursing Homes.Health services insights · 2016Article
- Nurse Staffing Hours At Nursing Homes With High Concentrations Of Minority Residents, 2001-11.Health affairs (Project Hope) · 2015Article
- Trends in family ratings of experience with care and racial disparities among Maryland nursing homes.Medical care · 2014Article
- Nursing home staffing requirements and input substitution: effects on housekeeping, food service, and activities staff.Health services research · 2013Article
- What factors contribute to successful appeals of nursing homes' deficiencies in the informal dispute resolution process?Journal of the American Medical Directors Association · 2013Article
- Introducing the Best of the AcademyHealth Annual Research Meeting.Health services research · 2012Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
objectiveTo test the hypothesis that more stringent quality regulations contribute to better quality nursing home care and to assess their cost-effectiveness. DATA SOURCES/
settingPrimary and secondary data from all states and U.S. nursing homes between 2005 and 2006. STUDY
designWe estimated seven models, regressing quality measures on the Harrington Regulation Stringency Index and control variables. To account for endogeneity between regulation and quality, we used instrumental variables techniques. Quality was measured by staffing hours by type per case-mix adjusted day, hotel expenditures, and risk-adjusted decline in activities of daily living, high-risk pressure sores, and urinary incontinence. DATA COLLECTION: All states' licensing and certification offices were surveyed to obtain data about deficiencies. Secondary data included the Minimum Data Set, Medicare Cost Reports, and the Economic Freedom Index. PRINCIPAL
findingsRegulatory stringency was significantly associated with better quality for four of the seven measures studied. The cost-effectiveness for the activities-of-daily-living measure was estimated at about 72,000 in 2011/ Quality Adjusted Life Year.
conclusionsQuality regulations lead to better quality in nursing homes along some dimensions, but not all. Our estimates of cost-effectiveness suggest that increased regulatory stringency is in the ballpark of other acceptable cost-effective practices.
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Registered trials
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