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Quality of care in for-profit and not-for-profit nursing homes: systematic review and meta-analysis

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      Abstract

      Objective To compare quality of care in for-profit and not-for-profit nursing homes.Design Systematic review and meta-analysis of observational studies and randomised controlled trials investigating quality of care in for-profit versus not-for-profit nursing homes.Results A comprehensive search yielded 8827 citations, of which 956 were judged appropriate for full text review. Study characteristics and results of 82 articles that met inclusion criteria were summarised, and results for the four most frequently reported quality measures were pooled. Included studies reported results dating from 1965 to 2003. In 40 studies, all statistically significant comparisons (P<0.05) favoured not-for-profit facilities; in three studies, all statistically significant comparisons favoured for-profit facilities, and the remaining studies had less consistent findings. Meta-analyses suggested that not-for-profit facilities delivered higher quality care than did for-profit facilities for two of the four most frequently reported quality measures: more or higher quality staffing (ratio of effect 1.11, 95% confidence interval 1.07 to 1.14, P<0.001) and lower pressure ulcer prevalence (odds ratio 0.91, 95% confidence interval 0.83 to 0.98, P=0.02). Non-significant results favouring not-for-profit homes were found for the two other most frequently used measures: physical restraint use (odds ratio 0.93, 0.82 to 1.05, P=0.25) and fewer deficiencies in governmental regulatory assessments (ratio of effect 0.90, 0.78 to 1.04, P=0.17).Conclusions This systematic review and meta-analysis of the evidence suggests that, on average, not-for-profit nursing homes deliver higher quality care than do for-profit nursing homes. Many factors may, however, influence this relation in the case of individual institutions.

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      Most cited references 22

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      The quality of care. How can it be assessed?

       A Donabedian (2015)
      Before assessment can begin we must decide how quality is to be defined and that depends on whether one assesses only the performance of practitioners or also the contributions of patients and of the health care system; on how broadly health and responsibility for health are defined; on whether the maximally effective or optimally effective care is sought; and on whether individual or social preferences define the optimum. We also need detailed information about the causal linkages among the structural attributes of the settings in which care occurs, the processes of care, and the outcomes of care. Specifying the components or outcomes of care to be sampled, formulating the appropriate criteria and standards, and obtaining the necessary information are the steps that follow. Though we know much about assessing quality, much remains to be known.
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        Brain edema.

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          Nursing home profit status and quality of care: is there any evidence of an association?

          This article critically reviews the association between the profit status of North American nursing homes and the quality of care. Studies were identified by searching MEDLINE (January 1990-October 2002), reference lists, letters, commentaries, and editorials. The quality indicator(s) used to measure quality of care, and its relationship to profit status, was extracted from each publication. The study design and risk-adjustment methodologies used were also extracted. The interrater reliability for the extraction of these three items was determined to be 1.0, 0.6, and 0.8, respectively. A qualitative systematic review was performed using Donabedian's framework of structure, process, and outcome for analyzing medical quality of care. Empirical research in the past 12 years has found that systematic differences exist between for-profit and not-for-profit nursing homes. For-profit nursing homes appear to provide lower quality of care in many important areas of process and outcome.
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            Author and article information

            Affiliations
            [1 ]Department of Medicine, University of British Columbia, Vancouver, BC, Canada V5Z 1M9
            [2 ]Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada L8N 3Z5
            [3 ]Department of Surgery, McMaster University
            [4 ]The Institute for Work and Health, Toronto, ON, Canada M5G 2E9
            [5 ]Department of Medicine, Division of Gastroenterology, University of Toronto, Toronto, M5T 2S8
            [6 ]St Michael’s Hospital, Toronto, M5B 1W8
            [7 ]Keenan Research Centre and Li Ka Shing Knowledge Institute, Toronto, M5B 1W8
            [8 ]Cancer Care Ontario, Toronto, M5G 2L7
            [9 ]Department of Clinical Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre-RS, Brazil
            [10 ]Italian National Cancer Institute Regina Elena, Rome, 00144, Italy
            [11 ]Health Sciences Library, McMaster University
            Author notes
            Correspondence to: P J Devereaux  philipj@ 123456mcmaster.ca
            Contributors
            Role: resident
            Role: associate professor
            Role: statistician
            Role: resident
            Role: research associate, Role: scientist
            Role: resident
            Role: staff physician
            Role: associate professor
            Role: assistant professor
            Role: professor
            Role: professor
            Role: president and CEO
            Role: professor
            Role: associate professor
            Role: resident
            Role: associate professor
            Role: assistant professor
            Role: professor
            Role: summer research assistant
            Role: reference librarian
            Role: professor
            Journal
            BMJ
            bmj
            BMJ : British Medical Journal
            BMJ Publishing Group Ltd.
            0959-8138
            1468-5833
            2009
            2009
            04 August 2009
            : 339
            2721035
            19654184
            comv617878
            10.1136/bmj.b2732

            This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

            Product
            Categories
            Research
            Clinical trials (epidemiology)
            Dermatology
            Quality improvement

            Medicine

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