| Nursing home quality has been the target of reform efforts following reports of widespread problems with the quality of care and quality of life in these facilities. By comparing two classification systems of all (n=15,006) Medicare and Medicaid-certified free-standing nursing homes operating between January 1, 2003 and September 1, 2004, this study examines the relationship among strategy, structure, operations, and outcomes. The data sources for this study include the chain-linked Online Survey and Certification Reporting System (OSCAR) and the Area Resource Files (ARF).;The results suggest that a classification system based on ownership and chain affiliation is meaningful: several hypotheses regarding the structure and operations of various classes of nursing homes are supported. On average, non-profit nursing homes use more nursing staff and have a more skilled mix of nursing staff than for-profit nursing homes. Additionally, non-profit nursing homes are less likely than for-profit nursing homes to receive a quality-related survey deficiency, and are less likely to use catheters, psychoactive medications, and restraints. A classification system derived from strategic management theory identifies at least nine distinct strategic groups of individual nursing homes that exhibit different configurations and outcomes. Using chain-level means and standard deviations to devise a classification system of chains, there are ten distinct strategic groups of nursing home chains. Concerns about ownership, chain affiliation, competition, staffing levels, and Medicaid payment levels are evaluated using multivariate regression analyses stratified by nursing home class.;The number of registered nurses (RNs) per resident is consistently related to the receipt of quality-related survey deficiencies: facilities with more RNs are less likely to be cited for a quality-of-care or quality-of-life problem. Across strategic groups, neither competition nor Medicaid payment rates are consistently associated with nursing home outcomes. Based on this cross-sectional examination, further development of a nursing home classification system appears warranted because strategic groups display different risk-adjusted correlates of performance. Accordingly, policy-makers may want to consider routine data collection of measures that are not mandated. |
