An analysis of participation, quality of care and efficiency outcomes of an inter-organizational network of nursing homes

In providing for residents, the average nursing home today must deal with complicated and competing issues that involve adhering to regulatory guidelines for quality of care while maintaining operations with limited reimbursement. In response to these challenges, many nursing homes establish external, collaborative efforts or "networks" to further common interests through collective action (Olson, 1965). This dissertation examines the Pioneer Network, an inter-organizational network that claims positive quality of care and efficiency outcomes are associated with network participation. To test these assertions and to further elucidate network participation, this research pursues the following objectives: (1) examine the organizational characteristics of early adopter homes participating in the Pioneer Network and to what extent those characteristics contributed to significant transformations in financial and quality outcomes (2) evaluate the effect of Pioneer Network participation on quality of care and per bed net income of nursing homes.;In the evaluation of the organizational characteristics of early adopter homes of the Pioneer Network, results suggest that the early adopters of the Pioneer Network were more likely to be large, non-profit and composed of a higher percentage of private paying residents. To determine the outcomes of homes participating in the Pioneer Network by organizational characteristic, this dissertation employs a difference-in-difference approach to examine significant changes from 1996 to 2003 in quality of care and profitability for four organizational characteristics including profit type, home size, chain status and market concentration. Findings imply that non-profit homes exhibited a greater change over for-profit homes in all quality of care and profitability outcomes. In addition, homes in less competitive environments significantly improved in quality of care and profitability over homes in more competitive environments.;This dissertation also evaluates the effect of Pioneer Network participation on quality of care for nursing home residents and the per bed net income of the home from 1996 to 2003. For quality of care, findings indicate homes participating in the Pioneer Network achieved better quality of care outcomes for residents over comparable nonparticipant homes between the two timeframes. Results of the profitability analysis also suggest that homes participating in the network outperformed control homes during the same timeframe.;Thus, this dissertation provides insight into the Pioneer Network. From a scholarly perspective, this dissertation integrates multiple theoretical frameworks to study the motivations for and outcomes of network participation in a complex environment. Since these results intimate that the relationship between quality and profit in Pioneer Network homes is positive, this research could inform government policy by further elucidating the value of this type of innovation for both homes and residents.