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Organizational Characteristics and Cancer Care for Nursing Home Residents

Authors

  • Jan P. Clement,

    1. Department of Health Administration, Virginia Commonwealth University, 1008 Clay Street, PO Box 980203, Richmond, VA 23298-0203,
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    • Address correspondence to Jan P. Clement, Ph.D., Professor, Department of Health Administration, Virginia Commonwealth University, 1008 Clay Street, PO Box 980203, Richmond, VA 23298-0203; e-mail: jclement@vcu.edu. Cathy J. Bradley, Ph.D., is with the Department of Public Health Management and Policy and Massey Cancer Center, Virginia Commonwealth University, Richmond, VA. Chunchieh Lin, M.B.A., Ph.D. Candidate, is with the Department of Health Administration, Virginia Commonwealth University, Richmond, VA.

  • Cathy J. Bradley,

    1. Department of Public Health Management and Policy and Massey Cancer Center, Virginia Commonwealth University, Richmond, VA,
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  • Chunchieh Lin

    1. Department of Health Administration, Virginia Commonwealth University, Richmond, VA
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Abstract

Objective. We evaluate whether organization, market, policy, and resident characteristics are related to cancer care processes and outcomes for dually eligible residents of Michigan nursing homes who entered facilities without a cancer diagnosis but subsequently developed the disease.

Data Sources/Study Design/Data Collection. Using data from the Michigan Tumor Registry (1997–2000), Medicare claims, Medicaid cost reports, and the Area Resource File, we estimate logistic regression models of diagnosis at or during the month of death and receipt of pain medication during the month of or month after diagnosis.

Principal Findings. Approximately 25 percent of the residents were diagnosed at or near death. Only 61 percent of residents diagnosed with late or unstaged cancer received pain medication during the diagnosis month or the following month. Residents in nursing homes with lower staffing and in counties with fewer hospital beds were more likely to be diagnosed at death. After the Balanced Budget Act (BBA), residents were more likely to be diagnosed at death.

Conclusions. Nursing home characteristics and community resources are significantly related to the cancer care residents receive. The BBA was associated with an increased likelihood of later diagnosis of cancer.

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