Quality of care in for-profit and not-for-profit nursing homes: systematic review and meta-analysis

Authors:
COMONDORE Vikram R., et al
Journal article citation:
British Medical Journal, 15.8.09, 2009, p.15.8.09.
Publisher:
British Medical Association

This systematic review and meta-analysis of observational studies and randomised controlled trials investigated quality of care in for-profit versus not-for-profit nursing homes. A comprehensive search yielded 8827 citations, of which 956 were judged appropriate for full text review. Study characteristics and results of 82 articles that met inclusion criteria were summarised, and results for the four most frequently reported quality measures were pooled. Included studies reported results dating from 1965 to 2003. In 40 studies, all statistically significant comparisons favoured not-for-profit facilities; in three studies, all statistically significant comparisons favoured for-profit facilities, and the remaining studies had less consistent findings. Meta-analyses suggested that not-for-profit facilities delivered higher quality care than did for-profit facilities for two of the four most frequently reported quality measures: more or higher quality staffing and lower pressure ulcer prevalence. Non-significant results favouring not-for-profit homes were found for the two other most frequently used measures: physical restraint use and fewer deficiencies in governmental regulatory assessments. This systematic review and meta-analysis of the evidence suggests that, on average, not-for-profit nursing homes deliver higher quality care than do for-profit nursing homes. Many factors may, however, influence this relation in the case of individual institutions.

Subject terms:
nursing homes, private sector, quality assurance, staffing levels, voluntary sector;
Content type:
systematic review
Link:
Journal home page
ISSN print:
1019-8350

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