Address correspondence to Dana B. Mukamel, Ph.D., Professor and Senior Fellow, University of California, Irvine, Center for Health Policy Research, 111 Academy, Suite 220, Irvine, CA; e-mail: firstname.lastname@example.org. Shubing Cai, Ph.D., Candidate in Health Services Research and Policy, and Helena Temkin-Greener, Ph.D., M.P.H., Associate Professor, are with the Department of Community and Preventive Medicine, University of Rochester School of Medicine, Rochester, NY.
Cost Implications of Organizing Nursing Home Workforce in Teams
Version of Record online: 26 MAY 2009
© Health Research and Educational Trust
Health Services Research
Volume 44, Issue 4, pages 1309–1325, August 2009
How to Cite
Mukamel, D. B., Cai, S. and Temkin-Greener, H. (2009), Cost Implications of Organizing Nursing Home Workforce in Teams. Health Services Research, 44: 1309–1325. doi: 10.1111/j.1475-6773.2009.00980.x
- Issue online: 10 JUL 2009
- Version of Record online: 26 MAY 2009
- Nursing homes;
- cost effectiveness
Objective. To estimate the costs associated with formal and self-managed daily practice teams in nursing homes.
Data Sources/Study Setting. Medicaid cost reports for 135 nursing homes in New York State in 2006 and survey data for 6,137 direct care workers.
Study Design. A retrospective statistical analysis: We estimated hybrid cost functions that include team penetration variables. Inference was based on robust standard errors.
Data Collection. Formal and self-managed team penetration (i.e., percent of staff working in a team) were calculated from survey responses. Annual variable costs, beds, case mix-adjusted days, admissions, home care visits, outpatient clinic visits, day care days, wages, and ownership were calculated from the cost reports.
Principal Findings. Formal team penetration was significantly associated with costs, while self-managed teams penetration was not. Costs declined with increasing penetration up to 13 percent of formal teams, and increased above this level. Formal teams in nursing homes in the upward sloping range of the curve were more diverse, with a larger number of participating disciplines and more likely to include physicians.
Conclusions. Organization of workforce in formal teams may offer nursing homes a cost-saving strategy. More research is required to understand the relationship between team composition and costs.