ArticleInquiry : a journal of medical care organization, provision and financing
Nursing Home Quality and Financial Performance: Is There a Business Case for Quality?
Article in Inquiry : a journal of medical care organization, provision and financing. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
27 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Pooled it
- The effect of civil money penalties on the financial performance of nursing homes.Innovation in aging · 2026Article
- Financial performance of rural and urban nursing homes: A comparative analysis.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025Article
- How Neighborhood Social Deprivation Is Associated With Nursing Home Quality: A Structure, Process, Outcome Model.Innovation in aging · 2025Article
- Skilled nursing facility staffing shortages: Sources, strategies, and impacts on staff who stayed.Health services research · 2024Article
- The Prevalence of Dysphagia in Individuals Living in Residential Aged Care Facilities: A Systematic Review and Meta-Analysis.Healthcare (Basel, Switzerland) · 2024Review
- Beyond the Balance Sheet: Investigating the Association Between NHA Turnover and Nursing Home Financial Performance.Risk management and healthcare policy · 2024Article
- Medicare skilled nursing facilities' occupancy and payer source: The moderating role of financial performance.SAGE open medicine · 2024Article
- Electronic Health Record Implementation Enhances Financial Performance in High Medicaid Nursing Homes.Journal of multidisciplinary healthcare · 2024Article
- Characteristics of United States nursing homes with high percentages of stage 2-4 pressure injuries among high-risk nursing home residents with obesity.Wound practice & research · 2023Article
- Implementation of US Post-Acute Care Payment Reform and COVID-19 Policies: Examining Experiences of Health System Leaders, Staff, Patients, and Family Caregivers-A Protocol.International journal of environmental research and public health · 2023Article
- The Impact of Wages on Care Home Quality in England.The Gerontologist · 2023Article
- Implementation of Goals of Care Communication Innovation Among Nursing Homes: A Multiple Case Study Design.Journal of the American Medical Directors Association · 2022Article
- Changing landscape of nursing homes serving residents with dementia and mental illnesses.Health services research · 2022Article
- Nursing Home Profit Margins and Citations for Infection Prevention and Control.Journal of the American Medical Directors Association · 2021Article
- Quality improvement studies in nursing homes: a scoping review.BMC health services research · 2021Article
- Shortages of Staff in Nursing Homes During the COVID-19 Pandemic: What are the Driving Factors?Journal of the American Medical Directors Association · 2020Article
- Higher Nursing Staff Wages Are Associated With Lower Operating Margins in Nursing Homes: An Instrumental Variable Analysis.Inquiry : a journal of medical care organization, provision and financingArticle
- Determinants of Successful Nursing Home Accreditation.Inquiry : a journal of medical care organization, provision and financingArticle
- What Counts in Nursing Homes' Quality and Efficiency? Results From Data Envelopment Analysis in Italy.Inquiry : a journal of medical care organization, provision and financingArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
Abstract
This study examines the relationship between nursing home quality and financial performance to assess whether there is a business case for quality. Secondary data sources included the Online Survey Certification and Reporting (OSCAR), Certification and Survey Provider Enhanced Reporting (CASPER), Medicare Cost Reports, Minimum Data Set (MDS 2.0), Area Resource File (ARF), and LTCFocus for all free-standing, nongovernment nursing homes for 2000 to 2014. Data were analyzed using panel data linear regression with facility and year fixed effects. The dependent variable, financial performance, consisted of the operating margin. The independent variables comprised nursing home quality measures that capture the three dimensions of Donabedian's structure-process-outcomes framework: structure Registered Nurse (RN) hours per resident day, Licensed Practical Nurse (LPN) hours per resident day, Certified Nursing Assistant (CNA) hours per resident day, RN skill mix), process (facility-acquired restraints, facility-acquired catheters, pressure ulcer prevention, and restorative ambulation), and outcomes (facility-acquired contractures, facility-acquired pressure ulcers, hospitalizations per resident, rehospitalizations, and health deficiencies). Control variables included size, average acuity index, market competition, per capita income, and Medicare Advantage penetration rate. This study found that the operating margin was lower in nursing homes that reported higher LPN hours per resident day and higher RN skill mix (structure); higher use of catheters, lower pressure ulcer prevention, and lower restorative ambulation (process); and more residents with contractures, pressure ulcers, hospitalizations and health deficiencies (outcomes). The results suggest that there is a business case for quality, whereas nursing homes that have better processes and outcomes of care perform better financially.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.