RESUMO
BACKGROUND: Efforts to increase transparency and accountability of nursing homes, and thus improve quality, now include information about changes in nursing home ownership. However, little is known about how change in ownership affects nursing home quality. METHODS: We conducted a retrospective cohort study of 15,471 U.S. nursing homes between January 2016 and December 2022, identifying all changes in ownership during that period. We used logistic regression to measure the association between nursing home characteristics and the odds of a change in ownership. A difference-in-differences model with multiple time periods was used to examine the impact of a change in ownership on the Medicare Nursing Home Compare 5-star ratings. RESULTS: One in five (23%) facilities changed ownership between 2016 and 2022. Nursing homes that were urban, for-profit, part of a chain, located in the South, had >50 beds, lower occupancy, higher percentage of stays covered by Medicaid, higher percentage of residents with non-white race, or a 1-star (poor) rating were more likely to undergo a change in ownership. There was a small statistically significant decrease in 5-star ratings after a change in ownership (-0.09 points on a 5-point scale; 95% CI -0.13 to -0.04; p < 0.001), driven primarily by a decrease in staffing ratings (-0.19 points; 95% CI -0.24 to -0.14; p < 0.001), and health inspections ratings (-0.07 points; 95% CI -0.11 to -0.03; p = 0.001). This was mitigated by an increase in quality measure ratings (0.15 points; 95% CI 0.10-0.20; p < 0.001). CONCLUSION: Nursing Home Compare ratings decreased slightly after a change in facility ownership, driven by lower staffing and health inspection ratings and mitigated somewhat by higher quality measure ratings. These conflicting trends underscore the need for transparency around changes in facility ownership and a better understanding of consequences of changes in ownership that are salient to patients and families.
RESUMO
Increased engagement of nurse practitioners (NPs) has been recommended as a way to address care delivery challenges in settings that struggle to attract physicians, such as primary care and rural areas. Nursing homes also face such physician shortages. We evaluated the role of state scope of practice regulations on NP practice in nursing homes in 2012-2019. Using linear probability models, we estimated the proportion of NP-delivered visits to patients in nursing homes as a function of state scope of practice regulations. Control variables included county demographic, socioeconomic, and health care workforce characteristics; state fixed effects; and year indicators. The proportion of nursing home visits conducted by NPs increased from 24% in 2012 to 42% in 2019. Expanded scope of practice regulation was associated with a greater proportion and total volume of nursing home visits conducted by NPs in counties with at least 1 NP visit. These relationships were concentrated among short-stay patients in urban counties. Removing scope of practice restrictions on NPs may address clinician shortages in nursing homes in urban areas where NPs already practice in nursing homes. However, improving access to advanced clinician care for long-term care residents and for patients in rural locations may require additional interventions and resources.
RESUMO
Using a cascade impactor (Andersen Series NVA-800), the size-segregated atmospheric particulates were collected daily and characters of lead contents and size distribution in the particles were analyzed from melting preparation, blast furnace smelting and lead-cast processes within a lead-zinc smelter in Shaanxi province. The results showed that emissions of particulate matter were different in different processes, in which the emissions of blast furnace smelting process was 402.83 mg x h(-1), while melting preparation were 182.71 mg x h(-1) and 100.03 mg x h(-1) in lead-cast processes. Lead contents in different sizes of particles varied in different processes. The mass fraction of lead were 111.54 mg x kg(-1), 68.54 mg x kg(-1) and 10.5 mg x kg(-1) in melting preparation, blast furnace smelting and lead-cast respectively. For lead's size distribution, the melting preparation and blast furnace smelting were mainly concentrated in the coarse particles, and the lead proportion in coarse and fine particles was approximately in lead-cast processes. The proportions of lead in coarse particles were 43.42% and 47.48% in melting preparation and blast furnace smelting process respectively, while the proportion of lead in coarse and fine particles was 37.14% and was 45.72% in lead-cast processes. There had peaks in both coarse and fine particles of melting preparation and lead-cast process, but the lead peak appeared only in the coarse particles of blast furnace smelting. It also indicated that the lead's cumulative frequencies of all processes were conforming to lognormal distribution.