The Relationship between Costs and Quality in Veterans Health Administration Community Living Centers: An Analysis Using Longitudinal Data. (18th May 2018)

• Record Type: Journal Article
• Authors: Burgess, James F.; Shwartz, Michael; Stolzmann, Kelly; Sullivan, Jennifer L.
• Is Part Of: Health services research. Volume 53:Number 5(2018)
• Page Start: 3881
• Page End: 3897
• Publication Date: 2018-05-18
• Subjects: Cost‐quality tradeoff -- composite quality measures -- nursing home costs -- nursing home outcomes; Medical care -- Periodicals; Medical care -- Evaluation -- Periodicals; Hospital care -- Periodicals; Health services administration -- Periodicals; 362
• DOI: 10.1111/1475-6773.12975
• Languages: English
• ISSNs: 0017-9124

Abstract

Abstract : Objective: To examine the relationship between cost and quality in Veterans Health Administration (VA) nursing homes (called Community Living Centers, CLCs) using longitudinal data. Data Sources/Study Setting: One hundred and thirty CLCs over 13 quarters (from FY2009 to FY2012) were studied. Costs, resident days, and resident severity (RUGs score) were obtained from the VA Managerial Cost Accounting System. Clinical quality measures were obtained from the Minimum Data Set, and resident‐centered care (RCC) was measured using the Artifacts of Culture Change Tool. Study Design: We used a generalized estimating equation model with facilities included as fixed effects to examine the relationship between total cost and quality after controlling for resident days and severity. The model included linear and squared terms for all independent variables and interactions with resident days. Principal Findings: With the exception of RCC, all other variables had a statistically significant relationship with total costs. For most poorer performing smaller facilities (lower size quartile), improvements in quality were associated with higher costs. For most larger facilities, improvements in quality were associated with lower costs. Conclusions: The relationship between cost and quality depends on facility size and current level of performance.