Nursing homes are critical components of the LTC continuum. Acute care systems recognize the need for high quality and easily accessible post-acute LTC (rehabilitation), as niche nursing homes have embraced over the past several years. Post-acute patients receiving skilled nursing facility rehabilitation now account for almost 20% of total nursing home days (Tyler et al., 2013). While nursing home quality is dependent on a number of workforce factors, physicians are clearly an important part of the team. Primary care physicians often graduate and enter practice without any meaningful exposure to post-acute LTC (PA-LTC) or to geriatric medicine in general. While the evidence linking nurse staffing, competence, and clinical quality is well-accepted, an analogous link between physician care and quality is still being defined. In this project, a previously-validated survey of nursing home medical staff organization will be conducted among a random sample of nursing home medical directors in four representative states, with support of AMDA-The Society for Post-Acute and Long-Term Care Medicine and collaboration from colleagues at Florida State University and University of Rochester. The data will describe the composition of nursing home medical staff, cohesion of providers, and commitment of providers, all of which affect nursing home quality. The underlying hypothesis is that physician care is a significant driver of nursing home quality. The results of this project will provide critical information to BHW on the extent to which physicians, NPs, and PAs practice in nursing homes as well as the barriers they face in their nursing home practice. These data will guide the development of training programs to enhance the capacity of physicians, NPs, and PAs to provide services within nursing homes. The survey also will be designed to facilitate future research on medical practice in nursing homes.
Key Questions
- What is the composition of nursing home medical staff, including number of providers, mix of physicians, NPs, and PAs, and whether it is a closed staff model?
- What processes are used by nursing homes to grant attending privileges? Do they employ physicians directly?
- What is the cohesion of providers within the medical staff in terms of their shared decision-making and organizational loyalty?
- What are the cultural expectations of physicians with respect to monitoring NP and PA work, allowing them independence, and their involvement in care planning meetings?
- What is the quality of relationships between medical directors and administrators?
For questions, contact: Joanne Spetz, [email protected]