Skip to main content

Advertisement

SpringerLink
Log in

The Measurement of Nursing Home Quality: Multilevel Confirmatory Factor Analysis of Panel Data

  • Published:
Journal of Medical Systems Aims and scope Submit manuscript

Abstract

This study examined the validity of a measurement model of nursing home quality by using multilevel confirmatory factor analysis. Based on Mullan and Harrington’s (2001) facility-level quality measurement model, a two-level analysis (facility and state) of the measurement model were performed. Two research questions were asked: (1) Can the measurement model developed at the facility-level be applied to state-level nursing home quality measurement? (2) Is the measurement model of nursing home quality stable over time? Panel data of 1997 and 2001, from the national OSCAR database, were used to test the assumptions. The results show that the state-level measurement model fits the data better than the facility-level model does. When the indicator “assessment” was removed from the state-level measurement model, a better-fitted measurement model was found. The two-level measurement model is relatively stable over time, demonstrating the construct validity of this measurement model.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Harrington, C., Swan, J., Nyman, J., and Carrillo, H., The effect of certification of need and moratoria policy on change in nursing home beds in the United States. Med. Care 35(6):574–588, 1997.

    Article  PubMed  Google Scholar 

  2. Harrington, C., Swan, J., Wellin, V., Clemeña, W., and Carriloo, H., 1996 State Data Book on Long-term Care Program and Market Characteristics, University of California, CA, 1998.

    Google Scholar 

  3. Harrington, C., Mullan, J., Woodruff, L. C., Burger, S. G., Carrillo, H., and Bedney, B., Stakeholders’ opinions regarding important measures of nursing home quality for consumers. Am. J. Med. Qual. 14(3):124–132, 1999.

    PubMed  Google Scholar 

  4. Harrington, C., Residential nursing facilities in the United States. Br. Med. J. 323:507–510, 2001.

    Google Scholar 

  5. Wan, T. T. H., Nursing care quality in nursing homes: Cross-sectional versus longitudinal analysis. J. Med. Syst. 27(3):283–295, 2003.

    Article  PubMed  Google Scholar 

  6. Zimmerman, D. R., Karon, S. L., Arling, G., Clark, B. R., Collins, T., Ross, R., and Sainfort, F., Development and testing of nursing home quality indicators. Health Care Financ. Rev. 16(4):107, 1995.

    PubMed  Google Scholar 

  7. Mullan, J. T., and Harrington, C., Nursing home deficiencies in the United States: A confirmatory factor analysis. Res. Aging 23(5):503–531, 2001.

    Google Scholar 

  8. Harrington, et al. Centers for Medicare and Medicaid Services, Nursing facilities, staffing, residents and facility deficiencies, 1993 through 1999, 2001.

  9. Institute of Medicine, Improving the Quality of Care in Nursing Homes, National Academy Press, Washington, DC, 1986.

    Google Scholar 

  10. Institute of Medicine, Improving the Quality of Care in Nursing Homes, National Academy Press, Washington, DC, 2001.

    Google Scholar 

  11. General Accounting Office, California nursing homes: Care problems persist despite federal and state oversight. Pub. No. NEHS-98-202, 1998.

  12. General Accounting Office, Nursing Homes: Additional Steps Needed to Strengthen Enforcement of Federal Quality Standards, Government Printing Office, Washington, DC, 1999.

    Google Scholar 

  13. Nyman, A. J., Improving the quality of nursing home outcomes. Are adequacy- or incentive-oriented policies more effective? Med. Care 26(12):1158–1171, 1988.

    PubMed  Google Scholar 

  14. Grabowski, C. D., Medicaid reimbursement and the quality of nursing home care. J. Health Econ. 20:549–569, 2001.

    Article  PubMed  Google Scholar 

  15. Wan, T. T. H., and Connell, A. M., Monitoring the Quality of Health Care: Issues and Scientific Approaches, Kluwer Academic Publishers, Norwell, MA, 2003.

    Google Scholar 

  16. Rantz, M. J., Mehr, D. R., Petroksi, G. F., Madsen, R.W., Popejoy, L., Hicks, L. L., Conn, V. S., Grando, V. T., Wipke-Tevis, D. D., Bostick, J., Porter, R., Zwygart-Stauffacher, M., and Maas, M., Initial field testing of an instrument to measure: observable indicators of nursing home care quality. Journal of Nursing Care Quality 14(3):1–12, 2000.

    Google Scholar 

  17. Harris, Y., and Clauser, S. B., Achieving improvement through nursing home quality measurement. Health Care Financing Review 23(4):5, 2002.

    PubMed  Google Scholar 

  18. Morris, J., Murphy, K., Mor, V., Berg, K., and Moore, T., Validation of long-term and post-acute care quality indicators. CMS Report. Contract No: 500-95-0062/T.O. #4, 2003.

  19. Greene, L. V., and Monahan, J. D., Structural and operational factors affecting quality of patient care in nursing homes. Public Policy 29:399–415, 1981.

    PubMed  Google Scholar 

  20. Elwell, F., The effects of ownership on institutional services. The Gerontol. 24:77–83, 1984.

    Google Scholar 

  21. Linn, M. W., Gurel, L., and Linn, B. S., Patient outcome as a measure of quality of nursing home care. Am. J. Public Health 67:337–344, 1977.

    PubMed  Google Scholar 

  22. Kane, A. R., and Kane, R. L., Long-term care: Variations on a quality assurance theme. Inquiry 25:132–146, 1988.

    PubMed  Google Scholar 

  23. Kane, R. L., Garrard, J., Skay, C. L., Radosevich, D. M., Buchanan, J. L., McDermott, S. M., Arnold, S. B., and Kepferle, L., Effects of a geriatric nurse practitioner on process and outcome of nursing home care. Am. J. Public Health 79(9):1271–1277, 1989.

    PubMed  Google Scholar 

  24. Gustafson, D. H., Sainfort, F., Van Konigsveld, R., and Zimmerman, D. R., The quality assessment index for measuring nursing home quality, Health Serv. Res. 25(1):97–127, 1990.

    PubMed  Google Scholar 

  25. Philips, C. D., Hawes, C., and Fries, B. E., Reducing the use of physical restraints in nursing homes: Will it increase costs? Am. J. Public Health 83:342–348, 1993.

    PubMed  Google Scholar 

  26. Angelelli, J., Mor, V., Intrator, O., Feng, Z., and Zinn, J., Oversight of nursing homes: pruning the tree or just spotting bad apples? The Gerontol. 43(2):67–75, 2003.

    Article  Google Scholar 

  27. Wan, T. T. H., and Unruh, L., A systems framework for evaluating nursing care quality in nursing homes. J. Med. Syst. 28(2):197–214, 2004.

    Article  PubMed  Google Scholar 

  28. Harrington, C., Zimmerman, D., Karon, S. L., Robinson, J., and Bentel, P., Nursing home staffing and its relationship to deficiencies. J. Gerontol. 55:278–287, 2000.

    Article  Google Scholar 

  29. Konetzka, R. T., Yi, D., Norton, C. E., and Kilpatrick, E. K., Effects of medicare payment changes on nursing home staffing and deficiencies. Health Serv. Res. 39(3):463–488, 2004.

    Article  PubMed  Google Scholar 

  30. Zinn, J., Mor, V., Intrator, O., Feng, Z., Angelelli, J., and Davis, J., The impact of the prospective payment system for skilled nursing facilities on therapy service provision: A transaction cost approach. Health Serv. Res. 38(6):1467–1485, 2003.

    Article  PubMed  Google Scholar 

  31. Castle, G. N., Providing outcomes information to nursing homes: Can it improve quality of care. The Gerontol. 43(4):483–492, 2003.

    Google Scholar 

  32. Wan, T. T. H., Evidence-based Health Care Management, Kluwer Academic Publishers, Norwell, MA, 2002.

    Google Scholar 

  33. Hox, J. J., Applied Multilevel Analysis, TT-Publikaties, Amsterdam, The Netherlands, 1995.

    Google Scholar 

  34. Kreft, Ita. G. G., Van de Leeuw, J., and Van der Leeden, R., Review of five analysis programs: BMDP-5V, GENMOD, HLM, ML3, VARCL. The Am. Statistician 48:324–335, 1994.

    Google Scholar 

  35. Little, T. D., Schnabel, K. U., and Baumert, J., Modeling Longitudinal and Multilevel Data: Practical Issues, Applied Approaches, and Specific Examples, Lawrence Erlbaum, Mahwah, NJ, 2000.

    Google Scholar 

  36. Heck, R. H., and Thomas, S. L., An Introduction to Multilevel Modeling Techniques, Lawrence Erlbaum Associates, Mahwah, NJ, 2000.

    Google Scholar 

  37. Muth$n, K. L., and Muth$n, B. O., Mplus user’s Guide, Los Angeles, CA, 1998.

Download references

Author information

Authors and Affiliations

  1. Doctoral Program in Public Affairs, College of Health and Public Affairs, University of Central Florida, Orlando, Florida, 32816

    Ning Jackie Zhang & Thomas T. H. Wan

Authors
  1. Ning Jackie Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas T. H. Wan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ning Jackie Zhang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhang, N.J., Wan, T.T.H. The Measurement of Nursing Home Quality: Multilevel Confirmatory Factor Analysis of Panel Data. J Med Syst 29, 401–411 (2005). https://doi.org/10.1007/s10916-005-5898-6

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10916-005-5898-6

Key words

Search

Navigation