PHYSICIAN STAFFING PATTERNS CORRELATES OF NURSING-HOME CARE - AN INITIAL INQUIRY AND CONSIDERATION OF POLICY IMPLICATIONS

BACKGROUND: To determine, post-OBRA 1987, medical organization in nurs ing facilities (ie, medical director and staff profile, closing of med ical staff, use of physician contract); structural correlates of medic al organization; and links between medical organization, especially cl osed staffing, and medical care.METHOD: Mail survey of New York state nursing facility administrators (63% response). Survey consisted of op en and closed end items that focused on facility and staff demographic s, medical organization, and markers of medical care delivery, ie, phy sicians' daily presence, average response time to emergency calls, cro ss coverage for acute conditions and emergencies, attendance at care c onferences, and offering of in-services. RESULTS: On average, faciliti es had 8.6 attending physicians, 32 residents per physician, 70% of re sidents cared for by non-staff physicians, no daily physician presence (60%), and no cross coverage. Most medical directors were from family (42%) or internal (55%) medicine, had a tenure of 7.5 years, did not have a certificate of added qualification in geriatrics (73%), and att ended residents (66%). Forty-three percent of facilities had closed me dical staffs, and 12% had physician contracts. Closed staffs were more likely in facilities that were larger, had more Medicaid residents, u sed physician extenders, and had more residents per nurse. Facilities with closed medical staffs had fewer physicians, more residents per ph ysician, and reported medical care practice patterns that would be ass ociated with quality of care. These effects were independent of nursin g and facility characteristics. Physician contract was unrelated to ca re. CONCLUSIONS: Medical organization and practice patterns emerge as important factors in considerations of nursing home quality. Results a rgue that, as in acute settings, limiting practice privileges in nursi ng homes may be a useful organizational strategy to improve quality of care.