Nursing home quality has been and continues to be a major concern for patients, their families, and health care policy makers. Over the last 2 decades, both the federal and state governments have engaged in efforts to address these concerns. These include the implementation of standard resident assessment and care planning tools, reforms of the state regulatory process, national and state publications of nursing home quality measures, national quality improvement activities by the Quality Improvement Organizations, and most recently the development of technical assistance (TA) programs in many states aimed at providing collaborative or non-punitive on-site consultation, training or sharing of best-practices with nursing facility staff. Despite these varied efforts, many quality problems persist, suggesting the need to understand the strengths and weaknesses of each of these initiatives. This study is designed to test the impact of the state initiated ? TA programs and their potential to contribute to better nursing home care. Nursing home TA programs vary substantially across states in terms of program structure (e.g., staffing pattern) and process (e.g., whether results of TA visits to facilities are shared with the state regulatory agency). Thus, their effectiveness is likely to vary as well. The natural variation in program characteristics offers us the ? opportunity to study the relationship between key components of the state TA program and high quality ? nursing home care. The main objective of the project is to inform policy by identifying aspects of the state TA program that contribute to better nursing home care.
Specific aims are to test the hypotheses that the key structural and process characteristics of state TA programs are associated with better risk-adjusted health outcomes of nursing home residents and lower case mix adjusted deficiency citations. Data will be collected from survey of state TA programs and several secondary databases. Multivariate regression analyses including instrumental variable analysis will be used for hypothesis testing.

Public Health Relevance

This study will examine the impact of the key structural and process components of state technical assistance programs on nursing home risk-adjusted health outcomes and case mix adjusted deficiency citations. We will combine data from different sources including a survey of state TA programs, and use statistical regression techniques including instrumental variable analysis for hypothesis testing. ? ? ?

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Project (R01)
Project #
Application #
Study Section
Nursing Science: Adults and Older Adults Study Section (NSAA)
Program Officer
Haaga, John G
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of California Irvine
Internal Medicine/Medicine
Schools of Medicine
United States
Zip Code
McGarry, Brian E; Strawderman, Robert L; Li, Yue (2014) The Care Span: Lower Hispanic participation in Medicare Part D may reflect program barriers. Health Aff (Millwood) 33:856-62
Li, Yue; Cai, Xueya (2014) Racial and ethnic disparities in social engagement among US nursing home residents. Med Care 52:314-21
McGarry, Brian E; Temkin-Greener, Helena; Li, Yue (2014) Role of race and ethnicity in private long-term care insurance ownership. Gerontologist 54:1001-12
Li, Yue; Cai, Xueya; Ye, Zhiqiu et al. (2013) Satisfaction with Massachusetts nursing home care was generally high during 2005-09, with some variability across facilities. Health Aff (Millwood) 32:1416-25
Li, Yue; Spector, William D; Glance, Laurent G et al. (2012) State ""technical assistance programs"" for nursing home quality improvement: variations and potential implications. J Aging Soc Policy 24:349-67
Li, Yue; Cai, Xueya; Yin, Jun et al. (2012) Is higher volume of postacute care patients associated with a lower rehospitalization rate in skilled nursing facilities? Med Care Res Rev 69:103-18
Li, Yue; Yin, Jun; Cai, Xueya et al. (2011) Association of race and sites of care with pressure ulcers in high-risk nursing home residents. JAMA 306:179-86
Li, Yue; Cai, Xueya; Cram, Peter (2011) Are patients with serious mental illness more likely to be admitted to nursing homes with more deficiencies in care? Med Care 49:397-405
Cai, Xueya; Cram, Peter; Li, Yue (2011) Origination of medical advance directives among nursing home residents with and without serious mental illness. Psychiatr Serv 62:61-6
Li, Yue; Glance, Laurent G; Yin, Jun et al. (2011) Racial disparities in rehospitalization among Medicare patients in skilled nursing facilities. Am J Public Health 101:875-82

Showing the most recent 10 out of 12 publications