Comparative and Cost-Effectiveness Analyses of Resident Quality Outcomes in Nursing Homes

Concerns about the quality of care in nursing homes (NHs) have continued to stimulate research and debate over the past several decades. Although substantial improvements in NH care have taken place, serious challenges remain. With enactment of the Patient Protection and Affordable Care Act (PPACA) and recent NH Value Based Purchasing Demonstrations through the Centers for Medicare and Medicaid Services (CMS), there has been increasing policy interest to efficiently reduce potentially avoidable resident adverse outcomes and costs. Organized into three separate studies, this dissertation explores the comparative and cost-effectiveness of improving NH quality outcomes. The significance and current challenges surrounding NH care quality is discussed in the First Chapter. To gain understanding of current infection prevention interventions conducted in NHs, a systematic literature review was conducted and is presented in Chapter Two. The Third Chapter reports on quantitative findings of NH infections as a function of resident quality and tested variations in nurse workforce characteristics. The Fourth Chapter reports on an economic analysis evaluating the implications of retaining a skilled nursing workforce in NHs. Finally, the Fifth Chapter synthesizes the findings from the previous chapters and serves as the concluding chapter of the dissertation.