Association Between Clinician Specialization in Nursing Home Care and Nursing Home Clinical Quality Scores.
Kira L Ryskina, Christine Lam, Hye-Young Jung
PMID 30745174WHAT IT FOUND
Nursing home regions with more clinicians whose billings were mostly for nursing home care had lower catheter and short-stay antipsychotic rates, but higher rates of residents with depressive symptoms.
This is a regional association, not proof of better individual care.
Key findings
01Regions with more nursing home specialists per 1,000 beds had lower catheter use and lower short-stay antipsychotic medication use.
02Greater nursing home clinician specialization was associated with an increase of 0.114 in the regional rate for residents with symptoms of depression, while urinary tract infections, restraints, and long-stay antipsychotic use were not significantly associated.
03Bottom-decile regions had 5% more short-stay antipsychotic events and 6% more long-stay indwelling bladder catheter events than top-decile regions.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is an ecological study of regions and nursing homes, not a test of a treatment for individual patients, so it cannot show that specialization causes better care. Regions with more specialists may differ in unobserved ways, such as work culture or medical staff organization. The quality measures were selected by the authors and may not all be under prescribing clinician control; some excluded measures may be. Clinician data could not be linked to specific nursing homes, so facility-level variation was obscured. Baseline adverse event rates were low, and the authors note a possible floor effect. The net effect was small compared with other nursing home factors, such as direct care staff hours.
Declared interests
The authors declared no conflicts of interest. The publication type lists research support from NIH, extramural.
The easy way to misread this
Do not read the lower catheter and antipsychotic rates as proof that more nursing home specialists improve care. This is an ecological association across regions, not a tested intervention, and the depression finding moved in the opposite direction.