Robert Weech-Maldonado
Datos Biográficos
| ID | 834615 |
|---|---|
| NOMBRE | Robert Weech-Maldonado |
| NOMBRES | Robert |
| APELLIDO | Weech-Maldonado |
| FIRMA | WEECH-MALDONADO R |
| AFILIACIONES | University of Alabama at Birmingham |
| ORCID | 0000-0002-5005-0909 |
| VERIFICADO | Sí |
| TOTAL DE OBRAS | 48 |
| TOTAL DE CITAS | 25 |
| TOTAL COMO AUTOR | 48 |
| TOTAL COMO EDITOR | 0 |
| PRIMER AÑO DE PUBLICACIÓN | 2003 |
| AÑO MÁS RECIENTE DE PUBLICACIÓN | 2026 |
| ÍNDICE H | 3 |
The Relationship Between Registered Nurse (RN) Skill Mix and QM Star Ratings in Nursing Homes
Nursing homes are under immense pressure to improve quality. The purpose of this study was to determine if there is a relationship between registered nurse (RN) skill mix (proportion of RN hours among all nursing staff hours) and higher quality measure (QM) star ratings. Data sets from 2021–2022 were utilized from the American Community Survey, Centers for Medicare and Medicaid Services (CMS), Medicare Cost Reports, Payroll-Based Journal, and Car…
Higher Nursing Staff Wages Are Associated With Lower Operating Margins in Nursing Homes
Nursing staff including registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs) are critical to nursing home (NH) operations but account for approximately 27% of net revenues. Understanding how nursing staff wages affect financial performance is particularly important as policy efforts seek to expand NH minimum staffing hours. Drawing from efficiency wage theory, which posits that employers may pay above…
The effects of private equity ownership in U.S. nursing homes quality and financial performance
Financial performance of rural and urban nursing homes
PURPOSE: The financial sustainability of nursing homes is increasingly critical as the aging US population continues to grow. Rural facilities often encounter more significant economic challenges than urban counterparts. This study investigates the disparities in financial performance between rural and urban nursing homes in the United States, emphasizing the influence of organizational and environmental factors. A comprehensive understanding of …
Comparison of Alternative Approaches to Using Race-and-Ethnicity Data in Estimating Differences in Health Care and Social Determinants of Health
OBJECTIVE: The objective of this study was to compare 2 approaches for representing self-reported race-and-ethnicity, additive modeling (AM), in which every race or ethnicity a person endorses counts toward measurement of that category, and a commonly used mutually exclusive categorization (MEC) approach. The benchmark was a gold-standard, but often impractical approach that analyzes all combinations of race-and-ethnicity as distinct groups. METH…
Threads of Care
OBJECTIVE: To assess the association of agency nursing staff utilization with nursing home (NH) quality. BACKGROUND: Nursing staff are the primary caregivers in NHs, where high-quality care is contingent upon their adequacy and expertise. Long-standing staffing challenges, exacerbated by the COVID-19 pandemic, have led NHs to rely on agency/contract labor to alleviate staffing shortages. METHODS: This study used the following secondary datasets: …
Covid-19 Pandemic Impact on Nursing Homes Financial Performance
Nursing homes expressed concern about potential severe adverse financial outcomes of COVID-19, with worries extending to the possibility of some facilities facing closure. Maintaining a strong financial well-being is crucial, and there were concerns that the pandemic might have significantly impacted both expenses and income. This longitudinal study aimed to analyze the financial performance of nursing homes during COVID-19 pandemic. Specifically…
Ownership Matters
Nursing homes (NHs) have long struggled with nurse shortages, leading to a greater reliance on agency nurses. The purpose of this study was to examine the impact of NH ownership on agency nurse utilization. Data were derived from multiple sources, including the Payroll-Based Journal and NH Five-Star Facility Quality Reporting System (n: 38,550 years: 2020-2022). A 2-part logistic regression model with 2-way fixed effects (state and year) was used…
The Immigrant Paradox
Resources availability and Covid-19 mortality among US counties
The COVID-19 was declared a pandemic by WHO on 03/2020 has claimed millions of lives worldwide. The US leads all countries in COVID-19-related deaths. Individual level (preexisting conditions and demographics) and county-level (availability of resources) factors have been attributed to increased risk of COVID-19-related deaths. This study builds on previous studies to assess the relationship between county-level resources and COVID-19 mortality a…
Rural disparities in the quality of clinical care are notable and larger for males
PURPOSE: To investigate whether rural-urban differences in quality of care for Medicare Advantage (MA) enrollees vary between females and males. METHODS: Data for this study came from the 2019 Healthcare Effectiveness Data and Information Set. Linear regression was used to investigate urban-rural differences in individual MA enrollee scores on 34 clinical care measures grouped into 7 categories, and how those differences varied by sex (through ev…
Patient Experience for Hispanic Older Adults Varies by Language Preference
BACKGROUND: Hispanic people with Medicare report worse patient experiences than non-Hispanic White counterparts. However, little research examines how these disparities may vary by language preference (English/Spanish). OBJECTIVES: Using Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data, assess whether 2014-2018 disparities in patient experiences for Hispanic people with Medicare vary by language preference. RES…
Disparities in Care Experienced by Older Hispanic Medicare Beneficiaries in Urban and Rural Areas
BACKGROUND: Hispanic older adults face substantial health disparities compared with non-Hispanic-White (hereafter "White") older adults. To the extent that these disparities stem from cultural and language barriers faced by Hispanic people, they may be compounded by residence in rural areas. OBJECTIVE: The objective of this study was to investigate possible interactions between Hispanic ethnicity and rural residence in predicting the health care …
High-Minority Nursing Homes Disproportionately Affected by Covid-19 Deaths
Racial/ethnic disparities in healthcare have been highlighted by the recent COVID-19 pandemic. Using the Centers for Medicare and Medicaid Services' Nursing Home COVID-19 Public File, this study examined the relationship between nursing home racial/ethnic mix and COVID-19 resident mortality. As of October 25, 2020, high minority nursing homes reported 6.5 COVID-19 deaths as compared to 2.6 deaths for nursing homes that had no racial/ethnic minori…
Culturally and Linguistically Appropriate Hospital Services Reduce Medicare Length of Stay
Our findings demonstrate that patient outcomes are responsive to culturally and linguistically appropriate services. Further, our findings suggest understanding of culturally competent care in hospitals is lacking. A larger and multi-level sample across the United States could yield a greater understanding of the role of culturally and linguistically appropriate care for a rapidly growing population of diverse older adults
Gender Differences in Patient Experience Across Medicare Advantage Plans
Predicting Nursing Home Financial Distress Using the Altman Z-Score
This article uses a modified Altman Z-score to predict financial distress within the nursing home industry. The modified Altman Z-score model uses multiple discriminant analysis (MDA) to examine multiple financial ratios simultaneously to assess a firm's financial distress. This study utilized data from Medicare Cost Reports, LTCFocus, and the Area Resource File. Our sample consisted of 167 268 nursing home-year observations, or an average of 10 …
Disparities in Care Experienced by American Indian and Alaska Native Medicare Beneficiaries
BACKGROUND: Little is known about the health care experiences of American Indians and Alaska Natives (AIANs) due to limited data. OBJECTIVE: The objective of this study was to investigate the health care experiences of AIAN Medicare beneficiaries relative to non-Hispanic Whites using national survey data pooled over 5 years. SUBJECTS: A total of 1,193,248 beneficiaries who responded to the nationally representative 2012-2016 Medicare Consumer Ass…
Reduction in Hospitals’ Readmission Rates
Hospital readmission within 30 days of discharge is an important quality measure given that it represents a potentially preventable adverse outcome. Approximately, 20% of Medicare beneficiaries are readmitted within 30 days of discharge. Many strategies such as the hospital readmission reduction program have been proposed and implemented to reduce readmission rates. Prior research has shown that coordination of care could play a significant role …
High Medicaid Nursing Homes
High Medicaid nursing homes (85% and higher of Medicaid residents) operate in resource-constrained environments. High Medicaid nursing homes (on average) have lower quality and poorer financial performance. However, there is significant variation in performance among high Medicaid nursing homes. The purpose of this study is to examine the organizational and market factors that may be associated with better financial performance among high Medicai…
Nursing Home Quality and Financial Performance
This study examines the relationship between nursing home quality and financial performance to assess whether there is a business case for quality. Secondary data sources included the Online Survey Certification and Reporting (OSCAR), Certification and Survey Provider Enhanced Reporting (CASPER), Medicare Cost Reports, Minimum Data Set (MDS 2.0), Area Resource File (ARF), and LTCFocus for all free-standing, nongovernment nursing homes for 2000 to…
Foreword to “Nursing Home Performance
This special collection explores the organizational and environmental factors influencing nursing home performance. The papers in this special collection fall into 3 broad themes. The first theme addresses issues related to nursing home quality measures and public reporting. The second group of papers examines how organizational resources and the environment may influence nursing home performance. The third group of papers examines the relationsh…
Indirect Estimation of Race/Ethnicity for Survey Respondents Who Do Not Report Race/Ethnicity
It may be worthwhile to impute race/ethnicity when this information is unavailable in survey data sets due to item nonresponse, especially when missingness is high
A Comparison of Methods for Classifying and Modeling Respondents Who Endorse Multiple Racial/Ethnic Categories
BACKGROUND: Race/ethnicity information is vital for measuring disparities across groups, and self-report is the gold standard. Many surveys assign simplified race/ethnicity based on responses to separate questions about Hispanic ethnicity and race and instruct respondents to "check all that apply." When multiple races are endorsed, standard classification methods either create a single heterogenous multiracial group, or attempt to impute the sing…
The Role of Assisted Living Capacity on Nursing Home Financial Performance
The rapid growth of the assisted living industry has coincided with decreased levels of nursing home occupancy and financial performance. The purpose of this article is to examine the relationships among assisted living capacity, nursing home occupancy, and nursing home financial performance. In addition, we explore whether the relationship between assisted living capacity and nursing home financial performance is mediated by nursing home occupan…
Moving towards culturally competent health systems
Racial and ethnic diversity and organizational behavior
Psychometric Properties of the Spanish Consumer Assessment of Health Plans Survey (CAHPS)
This study describes the psychometric properties of the Consumer Assessments of Health Plans Survey (CAHPS) in 279 persons who completed it in Spanish and 439 persons who completed it in English. We found negatively skewed distributions of responses and significant ceiling effects in both English and Spanish surveys. Cronbach’s alphas for English and Spanish multiple-item composites were 0.69 or higher. Correlations between the CAHPS measures and…
Contextual determinants of US nursing home racial/ethnic diversity
Comparison of Data Quality for Reports and Ratings of Ambulatory Care by African American and White Medicare Managed Care Enrollees
Higher missing data rates and lower plan-level reliability estimates for African American Medicare managed care enrollees suggest caution in making race/ethnicity comparisons. Future efforts are needed to enhance the quality of data collected from older African Americans
Race/Ethnicity, Language, and Patients' Assessments of Care in Medicaid Managed Care
Objective. Consumer assessments of health care provide important information about how well health plans and clinicians meet the needs of the people they serve. The purpose of this study was to examine whether consumer reports and ratings of care in Medicaid managed care vary by race/ethnicity and language. Data Sources. Data were derived from the National CAHPS ® Benchmarking Database (NCBD) 3.0 and consisted of 49,327 adults enrolled in Medicai…
Psychometric Properties of the Spanish Consumer Assessment of Health Plans Survey (CAHPS)
This study describes the psychometric properties of the Consumer Assessments of Health Plans Survey (CAHPS) in 279 persons who completed it in Spanish and 439 persons who completed it in English. We found negatively skewed distributions of responses and significant ceiling effects in both English and Spanish surveys. Cronbach’s alphas for English and Spanish multiple-item composites were 0.69 or higher. Correlations between the CAHPS measures and…
Racial and ethnic diversity and organizational behavior
Comparison of Data Quality for Reports and Ratings of Ambulatory Care by African American and White Medicare Managed Care Enrollees
Higher missing data rates and lower plan-level reliability estimates for African American Medicare managed care enrollees suggest caution in making race/ethnicity comparisons. Future efforts are needed to enhance the quality of data collected from older African Americans
Survey Response Style and Differential Use of CAHPS Rating Scales by Hispanics
BACKGROUND: Previous Consumer Assessments Of Healthcare Providers And Systems (CAHPS) studies have shown that Hispanics report care that is similar to or less positive than for non-Hispanic whites, yet have more positive ratings of care. OBJECTIVE: To examine differential use of the 0-10 rating scales in the CAHPS health plan survey by Hispanic ethnicity and insurance status (Medicaid vs. commercial managed care). DATA: CAHPS 2.0H adult Medicaid …
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Cultural Competence (CC) Item Set
BACKGROUND: There is a need for reliable and valid measures of cultural competence (CC) from the patient's perspective. OBJECTIVE: This paper evaluates the reliability and validity of the Consumer Assessments of Healthcare Providers and Systems (CAHPS) CC item set. RESEARCH DESIGN: Using 2008 survey data, we assessed the internal consistency of the CAHPS CC scales using the Cronbach α's and examined the validity of the measures using exploratory …
Risk Factors for Reporting Poor Cultural Competency Among Patients With Diabetes in Safety Net Clinics
BACKGROUND: The Consumer Assessment of Healthcare Providers and Systems Cultural Competency Item Set assesses patient perceptions of aspects of the cultural competence of their health care. OBJECTIVE: To determine characteristics of patients who identify the care they receive as less culturally competent. RESEARCH DESIGN: Cross-sectional survey consisting of face-to-face interviews. SUBJECTS: Safety-net population of patients with type 2 diabetes…
Evaluating Measurement Equivalence Across Race and Ethnicity on the CAHPS Cultural Competence Survey
BACKGROUND: The Consumer Assessments of Healthcare Providers and Systems (CAHPS) Cultural Competence Survey assesses patients' experiences with culturally competent care. This study evaluates the equivalence of responses to this survey across different racial and ethnic subgroups. In this study, we examined whether measurement bias on the CAHPS Cultural Competence Survey impedes valid measurement across white, black, and Hispanic patients. METHOD…
Does the Consumer Assessment of Healthcare Providers and Systems Cultural Competence Survey Provide Equivalent Measurement Across English and Spanish Versions
BACKGROUND: The English and Spanish versions of the Consumer Assessments of Healthcare Providers and Systems (CAHPS) Cultural Competence Survey (CAHPS-CC) assess patients' experiences with culturally competent care. The possibility exists that even when Spanish and English speakers experience the same levels of culturally competent care, responses describing their care may differ. This is called measurement bias. To deliver reliable and valid inf…
Advances in Measuring Culturally Competent Care
BACKGROUND: Providing culturally competent care shows promise as a mechanism to reduce health care inequalities. Until the recent development of the Consumer Assessment of Healthcare Providers and Systems Cultural Competency Item Set (CAHPS-CC), no measures capturing patient-level experiences with culturally competent care have been suitable for broad-scale administration. METHODS: We performed confirmatory factor analysis and internal consistenc…
Are There Differences in the Medicare Experiences of Beneficiaries in Puerto Rico Compared with Those in the U.S. Mainland
BACKGROUND: Little is known about the healthcare experiences of Medicare beneficiaries in Puerto Rico. OBJECTIVES: We compare the experiences of elderly Medicare beneficiaries in Puerto Rico with their English-preferring and Spanish-preferring Medicare counterparts in the U.S. mainland. RESEARCH DESIGN: Linear regression models compared mean Consumer Assessment of Healthcare Providers and Systems scores for these groups, using cross-sectional dat…
Can Hospital Cultural Competency Reduce Disparities in Patient Experiences With Care
BACKGROUND: Cultural competency has been espoused as an organizational strategy to reduce health disparities in care. OBJECTIVE: To examine the relationship between hospital cultural competency and inpatient experiences with care. RESEARCH DESIGN: The first model predicted Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores from hospital random effects, plus fixed effects for hospital cultural competency, individual r…
Racial/Ethnic Disparities in Medicare Part D Experiences
OBJECTIVE: To examine racial/ethnic differences in Medicare beneficiary experiences with Medicare Part D prescription drug (PD) coverage. DATA SOURCES/STUDY SETTING: 2008 Consumer Assessment of Health Care Providers and Systems survey of U.S. Medicare beneficiaries. STUDY DESIGN: Surveys were administered by mail with phone follow-up to a nationally representative sample (61% response rate). This study examines 201,496 beneficiaries of age 65 and…
Validly Interpreting Patients’ Reports
INTRODUCTION: Validly interpreting scores based on patients' reports of their experiences using scales depends on a valid scoring system. The possibility exists that, although the creators of a scale intended to create a scale measuring a single construct, the questions may seem to measure more than one construct. However, the possibility also exists that the questions do generally measure one construct, but several "nuisance" constructs influenc…
Moving towards culturally competent health systems
Contextual determinants of US nursing home racial/ethnic diversity
Country of Birth and Variations in Asthma and Wheezing Prevalence, and Emergency Department Utilization in Children
Racial/Ethnic Disparities in Medicare Beneficiaries’ Care Coordination Experiences
BACKGROUND: Little is known about racial/ethnic differences in the experience of care coordination. To the extent that they exist, such differences may exacerbate health disparities given the higher prevalence of some chronic conditions among minorities. OBJECTIVE: To investigate the extent to which racial/ethnic disparities exist in the receipt of coordinated care by Medicare beneficiaries. SUBJECTS: A total of 260,974 beneficiaries who responde…
Freestanding Emergency Departments Are Associated With Higher Medicare Costs
The number of freestanding emergency departments (FSEDs) is growing rapidly in the United States. Proponents of FSEDs cite potential benefits of FSEDs including lower waiting time and reduced travel distance for needed emergency care. Others have suggested that increased access to emergency care may lead to an increase in the use of emergency departments for lower acuity patients, resulting in higher overall health care expenditures. We examined …
Cost-effectiveness of Antihypertensive Medication
BACKGROUND: Antihypertensive medication decreases risk of cardiovascular disease (CVD) events in adults with hypertension. Although black adults have higher prevalence of hypertension and worse CVD outcomes compared with whites, limited attention has been given to the cost-effectiveness of antihypertensive medication for blacks. OBJECTIVE: To compare the cost-effectiveness of antihypertensive medication treatment versus no-treatment in white and …
The Role of Assisted Living Capacity on Nursing Home Financial Performance
The rapid growth of the assisted living industry has coincided with decreased levels of nursing home occupancy and financial performance. The purpose of this article is to examine the relationships among assisted living capacity, nursing home occupancy, and nursing home financial performance. In addition, we explore whether the relationship between assisted living capacity and nursing home financial performance is mediated by nursing home occupan…
Commentary
Safety of Obese Persons in Nursing Homes
Felix, Holly C. PhD, MPA*; Bradway, Christine PhD, CRNP, FAAN, AGSF†; Bird, Tommy Mac PhD*; Pradhan, Rohit PhD*; Weech-Maldonado, Robert PhD, MBA‡ Author Information
Factor Structure of the Cultural Competence Items in the National Home and Hospice Care Survey
BACKGROUND: There is a need for validated measures of cultural competency practices in home health and hospice care (HHHC). OBJECTIVE: To establish the factor structure of the cultural competency items included in the agency-component of the 2007 public-use National Home and Hospice Care Survey file. DATA SOURCE: We used weighted survey data from 1036 HHHC agencies. RESEARCH DESIGN AND PARTICIPANTS: We used exploratory factor analyses to identify…
Reduction in Hospitals’ Readmission Rates
Hospital readmission within 30 days of discharge is an important quality measure given that it represents a potentially preventable adverse outcome. Approximately, 20% of Medicare beneficiaries are readmitted within 30 days of discharge. Many strategies such as the hospital readmission reduction program have been proposed and implemented to reduce readmission rates. Prior research has shown that coordination of care could play a significant role …
Medicine (39 obras) · Health care (26 obras) · Nursing (22 obras) · Psychology (20 obras) · Ethnic group (18 obras) · Gerontology (16 obras) · Geriatric Care and Nursing Homes (15 obras) · Business (14 obras) · Cultural Competency in Health Care (13 obras) · Family medicine (13 obras)