A LONGITUDINAL ANALYSIS OF NURSING-HOME OUTCOMES

Objective. To investigate resident and facility attributes associated with long-term care health outcomes in nursing homes. Data Sources. Qu arterly Management Minutes Questionnaire (MMQ) survey data for Medicai d case-mix reimbursement of nursing homes in Massachusetts from 1991 t o 1994, for specification of outcomes and resident attributes. Facilit y attributes are specified from cost report data. Study Design. Multiv ariate logistic and ''state-dependence'' regression models are estimat ed for survival, ADL functional status, incontinence status, and menta l status outcomes from longitudinal residence histories of Medicaid re sidents spanning 3 to 36 months in length. Outcomes are specified to b e a function of resident demographic and diagnostic attributes and fac ility-level operating and nurse staffing attributes. Principal Finding s. The estimated parameters for resident demographic and diagnostic at tributes showed a great deal of construct validity with respect to cli nical expectations regarding risk factors for adverse outcomes. Few fa cility attributes were associated with outcomes generally, and none wa s significantly associated with all four outcomes. Conclusions. The ab sence of uniform associations between facility attributes and the vari ous long-term care health outcomes studied suggests that strong facili ty performance on one health outcome may coexist with much weaker perf ormance on other outcomes. This has implications for the aggregation o f individual facility performance measures on multiple outcomes and th e development of overall outcome performance measures.