J. Karuza et Pr. Katz, PHYSICIAN STAFFING PATTERNS CORRELATES OF NURSING-HOME CARE - AN INITIAL INQUIRY AND CONSIDERATION OF POLICY IMPLICATIONS, Journal of the American Geriatrics Society, 42(7), 1994, pp. 787-793
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.