***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES To compare black and white nursing home residents with respect to the incidence of nursing home (NH)-acquired pressure ulcers ( PUs )  and to examine the role of resident characteristics and facility characteristics in explaining differences between the racial groups . DESIGN Prospect i ve cohort study conducted between 1992 and 1995 . SETTING Fifty-nine Maryl and NHs . PARTICIPANTS A total of 1,938 residents ( 301 black , 1,637 white ) aged 65 and older newly admitted to participating NHs . MEASUREMENTS The outcome variable was the first occurrence of a Stage 2 , 3 , or 4 PU as determined based on medical record review . The predictor variable was race ( black , white ) . Eight resident characteristics ( age , sex , number of activity of daily living dependencies , bedfast , PU on admission to facility , incontinence , dementia , and whether the resident was on Medicaid ) and three facility characteristics ( number of beds , for-profit ownership status , and urban/nonurban location ) were considered as possible confounding variables . RESULTS The incidence of PUs was 0.38 per person-year in the NH . The rate for blacks was significantly higher than for whites ( 0.56 vs 0.35 per person-year ) ( P<.001 ) . In multivariate analysis , controlling for eight resident characteristics and three facility characteristics , race was significantly associated with PU incidence ( hazard ratio comparing blacks with whites=1.31 , 95 % confidence interval=1.02 - 1.66 ) . CONCLUSION Blacks have a higher incidence of NH-acquired PUs than whites ; resident characteristics appear to mediate the higher risk . Future research should aim to identify modifiable factors that explain differences between racial groups in PU risk and to develop solutions to prevent the suffering and cost associated with PUs OBJECTIVE Hospitalizations of nursing home residents are costly and expose residents to iatrogenic disease and social and psychological harm . Economic constraints imposed by payers of care , predominantly Medicaid policies , are hypothesized to impact hospitalizations . DATA SOURCES / STUDY SETTING Federally m and ated resident assessment s were merged with Medicare cl aims and eligibility files to determine hospitalizations and death within 150 days of baseline assessment . Nursing home and market characteristics were obtained from the Online Survey Certification and Reporting , and the Area Re source File , respectively . States ' average daily Medicaid nursing home payments and bed-hold policies were obtained independently . STUDY DESIGN Prospect i ve cohort study of 570,614 older ( > or = 65-year-old ) , non-MCO ( Medicare Managed Care ) , long-stay ( > or = 90 days ) residents in 8,997 urban , freest and ing nursing homes assessed between April and June 2000 , using multilevel models to test the impact of state policies on hospitalizations controlling for resident , nursing home , and market characteristics . PRINCIPAL FINDINGS Overall , 99,379 ( 17.4 percent ) residents were hospitalized with rates varying from 8.4 percent in Utah to 24.9 percent in Louisiana . Higher Medicaid per diem was associated with lower odds of hospitalizations ( 5 percent lower for each $ 10 above average $ 103.5 , confidence intervals [ CI ] 0.91 - 0.99 ) . Hospitalization odds were higher by 36 percent in states with bed-hold policies ( CI : 1.12 - 1.63 ) . CONCLUSIONS State Medicaid bed-hold policy and per-diem payment have important implication s for nursing home hospitalizations , which are predominantly financed by Medicare . This study emphasizes the importance of properly aligning state Medicaid and federal Medicare policies in regards to the subsidy of acute , maintenance , and preventive care in the nursing home setting Given the preferential tax treatment afforded nonprofit firms , policymakers and research ers have been interested in whether the nonprofit sector provides higher nursing home quality relative to its for-profit counterpart . However , differential selection into for-profits and nonprofits can lead to biased estimates of the effect of ownership form . By using " differential distance " to the nearest nonprofit nursing home relative to the nearest for-profit nursing home , we mimic r and omization of residents into more or less " exposure " to nonprofit homes when estimating the effects of ownership on quality of care . Using national Minimum Data Set assessment s linked with Medicare cl aims , we use a national cohort of post-acute patients who were newly admitted to nursing homes within an 18-month period spanning January 1 , 2004 and June 30 , 2005 . After instrumenting for ownership status , we found that post-acute patients in nonprofit facilities had fewer 30-day hospitalizations and greater improvement in mobility , pain , and functioning RESEARCH OBJECTIVE To assess the impact of recent Medicare prospect i ve payment system ( PPS ) changes on efficiency in skilled nursing homes . DATA SOURCE / STUDY SETTING Medicare Cost Reports ( MCR ) , On-line Survey Certification and Reporting System ( OSCAR ) , Area Re source Files ( ARF ) , a Centers for Medicare and Medicaid Services ( CMS ) hospital wage index website , a Consumer Price Index ( CPI ) data base , and a survey of state Medicaid reimbursement rates . The sample was 8,361 nursing homes in the Medicare Cost Report data bases from the years 1997 to 2003 . STUDY DESIGN Data -envelopment analyses ( DEA ) calculated efficiency scores for three separate DEA models : unadjusted , acuity-adjusted , and acuity- and - quality -adjusted efficiency . The efficiency scores from these models were regressed on the Medicare PPS changes ( the Balanced Budget Act [ BBA ] , the Balanced Budget Refinement Act [ BBRA ] and the Benefits Improvement and Protection Act ) and other organizational and market explanatory variables using a panel- data truncated regression . PRINCIPAL FINDINGS Mean values for all efficiency measures decreased over time , the acuity- quality -adjusted efficiency measures decreasing the most . All policy variables were significantly negatively related to all efficiency measures . Higher nurse staffing was negatively related to efficiency in all but the acuity- quality -adjusted model . Other explanatory variables varied in their relationships to the efficiency variables . CONCLUSIONS The results suggest that the reimbursement policy changes had a significantly negative impact on efficiency . Higher nurse staffing contributed to lower efficiency only when efficiency was not adjusted for quality . Various organizational and market factors also played significant roles in all efficiency models OBJECTIVES To assess Advisory Committee for Immunization Practice s recommendations for the pneumococcal vaccine in nursing home residents using national surveys to examine factors associated with vaccination . DESIGN Cross-sectional national sample surveys of nursing homes and nursing home residents with a two-stage probability design , stratified on size and Medicare and Medicaid certification status . SETTING U.S. nursing homes during 1995 , 1997 , and 1999 . PARTICIPANTS Six current residents were r and omly selected from each facility ( n = approximately 8,000 each year ) . MEASUREMENTS Residents '  pneumococcal vaccination status was obtained by asking the facility respondent for each resident : " Has [ the resident ] EVER had a pneumococcal vaccine , that is a pneumonia vaccination ? " Vaccination status was coded as yes , no , and unknown . RESULTS The proportion of residents aged 65 and older that received pneumococcal vaccination increased significantly , from 23.6 % in 1995 to 28.2 % in 1997 to 37.4 % in 1999 ( P<.001 ) . The proportion of residents in homes with pneumococcal immunization programs increased significantly , from 65.2 % in 1995 to 88.9 % in 1999 . CONCLUSION The proportion of  nursing home residents aged 65 and older  receiving the pneumococcal vaccine increased significantly from 1995 to 1999 . Residents living in nursing homes with programs for pneumococcal immunizations were significantly more likely to be vaccinated Background : The Balanced Budget Act of 1997 dramatically changed the way that Medicare pays skilled nursing facilities and also cut per-diem rates . Previous studies have found effects on facility-wide staffing but not on quality for short-stay residents . Because facilities may combine revenue streams to be used where needed , spillover effects on quality of care for long-stay residents are possible . Objective : We sought to investigate effects of financial pressures from Medicare payment changes on quality of care for long-stay residents . Methods : We investigated the effect of Medicare 's Prospect i ve Payment System for skilled nursing facilities on incidence of urinary tract infections and pressure sores among long-stay residents while controlling for resident severity . We conducted panel data analysis of nursing home residents in Ohio , Kansas , Maine , Mississippi , and South Dakota using Minimum Data Set data from 1995 to 2000 . Each facility 's Medicare dependence was used to separate effects of the policy from underlying industry trends . Results : The probability of developing a urinary tract infection or pressure sore increased significantly among long-stay residents after Medicare 's prospect i ve payment system was implemented . Effects were roughly proportional to the percent of residents in a facility covered by Medicare . Conclusions : Although Medicare prospect i ve payment and rate cuts were directly applicable only to Medicare ( largely short-stay ) residents in skilled nursing facilities , the result ing financial pressures lowered the quality of care experienced by long-stay residents , as measured by the likelihood of adverse outcomes . The observed quality decreases were likely due to decreases in nurse staffing prompted by the payment reductions OBJECTIVE To examine the efficiency of the care planning process in nursing homes . METHODS We collected detailed primary data about the care planning process  for a stratified r and om sample of 107 nursing homes from Kansas and Missouri . We used these data to calculate the average direct cost per care plan and used data on selected deficiencies from the Online Survey Certification and Reporting System to measure the quality of care planning . We then analyzed the efficiency of the assessment process using corrected ordinary least squares ( COLS ) and data envelopment analysis ( DEA ) . RESULTS Both approaches suggested that there was considerable inefficiency in the care planning process . The average COLS score was 0.43 ; the average DEA score was 0.48 . The correlation between the two sets of scores was quite high , and there was no indication that lower costs result ed in lower quality . For-profit facilities were significantly more efficient than not-for-profit facilities . CONCLUSIONS Multiple studies of nursing homes have found evidence of inefficiency , but virtually all have had measurement problems that raise questions about the results . This analysis , which focuses on a process with much simpler measurement issues , finds evidence of inefficiency that is largely consistent with earlier studies . Making nursing homes more efficient merits closer attention as a strategy for improving care . Increasing efficiency by adopting well- design ed , reliable processes can simultaneously reduce costs and improve quality OBJECTIVES To estimate the effect of state Medicaid nursing home reimbursement rates on hospitalizations of nursing home residents . DESIGN Cross-sectional sample of nongovernment-owned nursing homes with 25 beds or more in one Metropolitan Statistical Area in each of 10 states in 1993 , with 6 months follow-up on mortality and hospitalizations . SETTING Two hundred fifty-three nursing homes . PARTICIPANTS Eight to 16 r and omly selected residents from each facility , totaling 2,080 . MEASUREMENTS Minimum Data Set assessment s conducted by research nurses at baseline . A three-category 6-month outcome was defined as ( 1 ) any hospitalization ; for those not hospitalized , ( 2 ) death versus ( 3 ) alive in the facility . RESULTS Using multinomial logistic regression , adjusted to survey design , controlling for resident and facility characteristics , a 10 dollar increase in 1993 Medicaid reimbursement rate above the mean rate of approximately 75 dollars result ed in a 9 % reduction in a resident 's risk of hospitalization ( P<.05 ) . CONCLUSION State Medicaid reimbursement rates appear to affect clinical decisions regarding the need for hospital admission and thresholds for nursing home use . The findings from this study reemphasize the importance of properly aligning state Medicaid and federal Medicare long-term care policies because , currently , states have no incentive to increase reimbursement rates to avoid hospitalization OBJECTIVE To investigate the effects of  Medicare 's Prospect  i ve Payment System ( PPS ) for skilled nursing facilities ( SNFs ) and associated rate changes on quality of care as represented by staffing ratios and regulatory deficiencies . DATA SOURCES Online Survey , Certification and Reporting ( OSCAR ) data from 1996 - 2000 were linked with Area Re source File ( ARF ) and Medicare Cost Report data to form a panel data set . STUDY DESIGN A difference-in-differences model was used to assess effects of the PPS and the BBRA ( Balanced Budget Refinement Act ) on staffing and deficiencies , a design that allows the separation of the effects of the policies from general trends . Ordinary least squares and negative binomial models were used . DATA COLLECTION METHODS The OSCAR and Medicare Cost Report data are self-reported by nursing facilities ; ARF data are publicly available . Data were linked by provider ID and county . PRINCIPAL FINDINGS We find that professional staffing decreased and regulatory deficiencies increased with PPS , and that both effects were mitigated with the BBRA rate increases . The effects appear to increase with the percent of Medicare residents in the facility except , in some cases , at the highest percentage of Medicare . The findings on staffing are statistically significant . The effects on deficiencies , though exhibiting consistent signs and magnitudes 
    Output:
    
Findings : For-profit nursing homes tend to have better financial performance , but worse results with regard to employee well-being and client well-being , compared to not-for-profit sector homes .
We argue that the better financial performance of for-profit nursing homes seems to be associated with worse employee and client well-being .