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The Impact of Dementia Special Care Units on Quality of Care: An Instrumental Variables Analysis
Author(s) -
Joyce Nina R.,
McGuire Thomas G.,
Bartels Stephen J.,
Mitchell Susan L.,
Grabowski David C.
Publication year - 2018
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12867
Subject(s) - dementia , medicine , minimum data set , instrumental variable , long term care , endogeneity , data quality , emergency medicine , nursing homes , nursing , statistics , operations management , disease , metric (unit) , mathematics , economics
Objective To compare the quality of care following admission to a nursing home ( NH ) with and without a dementia special care unit ( SCU ) for residents with dementia. Data Sources/Study Setting National resident‐level minimum dataset assessments ( MDS ) 2005–2010 merged with Medicare claims and provider‐level data from the Online Survey, Certification, and Reporting database. Study Design We employ an instrumental variable approach to address the endogeneity of selection into an SCU facility controlling for a range of individual‐level covariates. We use “differential distance” to a nursing home with and without an SCU as our instrument. Data Collection/Extraction Methods Minimum dataset assessments performed at NH admission and every quarter thereafter. Principal Findings Admission to a facility with an SCU led to a reduction in inappropriate antipsychotics (−9.7 percent), physical restraints (−9.6 percent), pressure ulcers (−3.3 percent), feeding tubes (−8.3 percent), and hospitalizations (−14.7 percent). We found no impact on the use of indwelling urinary catheters. Results held in sensitivity analyses that accounted for the share of SCU beds and the facilities' overall quality. Conclusions Facilities with an SCU provide better quality of care as measured by several validated quality indicators. Given the aging population, policies to promote the expansion and use of dementia SCU s may be warranted.