David C Grabowski
Dados Biográficos
| ID | 1064211 |
|---|---|
| NOME | David C Grabowski |
| PRENOMES | David C |
| SOBRENOME | Grabowski |
| ASSINATURA | GRABOWSKI D C |
| AFILIAÇÕES | Harvard University |
| ORCID | 0000-0003-2915-5770 |
| VERIFICADO | Sim |
| TOTAL DE OBRAS | 44 |
| TOTAL DE CITAÇÕES | 27 |
| TOTAL COMO AUTOR | 44 |
| TOTAL COMO EDITOR | 0 |
| PRIMEIRO ANO DE PUBLICAÇÃO | 2001 |
| ANO MAIS RECENTE DE PUBLICAÇÃO | 2026 |
| ÍNDICE H | 3 |
Nursing Home Administrator Experiences Navigating the Changing Regulatory Environment During the Covid-19 Pandemic
156) with administrators of 40 nursing homes across the U.S. between July 2020 and December 2021 to better understand their experiences with governmental agencies amid shifting regulatory standards, frequent inspections, and possible enforcement actions. Administrators highlighted confusion due to the evolving and sometimes conflicting guidance between state and federal agencies, although some states offered valuable COVID-19-specific assistance.…
Facility-Level Differences in Antipsychotic Drug Use
OBJECTIVE: To quantify quality of care following an admission to a nursing home with low or high antipsychotic drug use. BACKGROUND: Misuse of antipsychotics in U.S. nursing homes is a huge concern for policymakers. METHODS: We utilized an instrumental variable approach to estimate the effect of facility-level antipsychotic use on patient outcomes. The instrument was the differential distance to the nearest low-use antipsychotic nursing home rela…
Differences in Initiation and Receipt of Home Health Care
BACKGROUND: Because Traditional Medicare (TM) and Medicare Advantage (MA) have different reimbursement structures and incentives, it is important to understand differences in home health agency (HHA) use by payer type. OBJECTIVE: To quantify differences in care patterns and outcomes between TM and MA HHA users. RESEARCH DESIGN AND SUBJECTS: Medicare HHA claims were used to identify postacute HHA episodes among US adults aged 65 and older enrolled…
Clinical Risk and Outpatient Therapy Utilization for Covid-19 in the Medicare Population
In this cross-sectional study, outpatient COVID-19 treatment was disproportionately accessed by beneficiaries at lower risk for severe infection, undermining its potential public health benefit. Undertreatment was not driven by lack of clinical access or treatment contraindications
Preferences for Postacute Care at Home vs Facilities
The findings of this survey study underscore a prevailing preference for home-based postacute care, aligning with current policy trends. However, attention is warranted for disadvantaged groups who are potentially overlooked during the shift toward home-based care, particularly those facing caregiver constraints and socioeconomic hardships. Ensuring equitable support and improved quality measure tools are crucial for promoting patient-centric pos…
Mental health in nursing homes
Changes in Care Associated With Integrating Medicare and Medicaid for Dual-Eligible Individuals
In this cohort study with a difference-in-differences analysis of 2 cohorts of individuals dually eligible for Medicare and Medicaid, integration was associated with greater HCBS use but not with other changes in care patterns. The findings highlight opportunities to strengthen how integrated programs manage care and a need to further evaluate their performance
Caregiving across generations
Staffing Patterns in US Nursing Homes During Covid-19 Outbreaks
In this cohort study of nursing homes experiencing severe COVID-19 outbreaks, facilities experienced considerable staffing challenges during and after outbreaks. These results suggest the need for policy action to ensure facilities' abilities to maintain adequate staffing levels during and after infectious disease outbreaks
Association of State Covid-19 Vaccine Mandates With Staff Vaccination Coverage and Staffing Shortages in US Nursing Homes
The findings of this cohort study suggest that state-level vaccine mandates were associated with increased staff vaccination coverage without increases in reported staffing shortages. Vaccination increases were largest when mandates had no test-out option and were also larger in Republican-leaning counties, which had lower mean baseline vaccination rates. These findings support the use of state mandates for booster doses for nursing home employee…
Association Between the Patient Driven Payment Model and Therapy Utilization and Patient Outcomes in US Skilled Nursing Facilities
In this cross-sectional study of SNF admission after PDPM implementation, a reduction of total therapy minutes was observed following the implementation of PDPM, even though PDPM was designed to be budget neutral. No significant changes in postacute outcomes were observed. Further study is needed to understand whether the PDPM is associated with successful discharge outcomes
Association Between New-Onset Medicaid Home Care and Family Caregivers’ Health
In this cohort study, Medicaid home care was associated with improvement in caregiver self-rated mental health, but not with any short-term change in self-rated physical health. When evaluating the social value of home care programs, policy makers should consider spillover benefits to caregivers
Nursing Homes and Covid-19
The COVID-19 pandemic has caused a staggering number of deaths and a great deal of suffering in U.S. nursing homes. The spread of the virus across the country introduced a new emergency to a long-term care sector that had already been in a state of crisis for multiple decades. Nursing homes have been underfunded and understaffed for years, often delivering inadequate care to their vulnerable residents, and they are financed and regulated separate…
Nursing Homes Are Ground Zero for Covid-19 Pandemic
At the start of 2020, the Life Care Center of Kirkland nursing home in Kirkland
Will Medicare’s New Patient-Driven Postacute Care Payment System Be a Step Forward
Skilled nursing facility (SNF) and home health agency (HHA) use and spending vary substantially across the US. However, higher spending on rehabilitation and nursing following a hospitalization has not necessarily led to better patient outcomes. 1 In 2017, approximately 1.6 million patients receiving Medicare fee-for-service benefits were admitted to a SNF, with an estimated annual cost of $28.4 billion, and 3.4 million patients received HHA serv…
Nursing Home Chain Affiliation and Its Impact on Specialty Service Designation for Alzheimer Disease
Specialty care units (SCUs) in nursing homes (NHs) grew in popularity during the 1990s to attract residents while national policies and treatment paradigms changed. Alzheimer disease has consistently been the dominant form of SCU. This study explored the extent to which chain affiliation, which is common among NHs, affected SCU bed designation. Using data from the Online Survey Certification and Reporting (OSCAR) from 1996 through 2010 with 207 4…
A Methodology to Identify a Cohort of Medicare Beneficiaries Residing in Large Assisted Living Facilities Using Administrative Data
BACKGROUND: Assisted living is a popular option for housing and long-term care. OBJECTIVE: To develop and test a methodology to identify Medicare beneficiaries residing in assisted living facilities (ALFs). RESEARCH DESIGN: We compiled a finder file of 9-digit ZIP codes representing large ALFs (25+ beds) by matching Outcome and Assessment Information Set (OASIS) assessments and Medicare Part B Claims to the Medicare enrollment records and address…
Constructing a Measure of Private-pay Nursing Home Days
BACKGROUND: Nursing home (NH) care is financed through multiple sources. Although Medicaid is the predominant payer for NH care, over 20% of residents pay out-of-pocket for their care. Despite this large percentage, an accepted measure of private-pay NH occupancy has not been established and little is known about the types of facilities and the long-term care markets that cater to this population. OBJECTIVES: To describe 2 novel measures of priva…
The Impact of Chain Standardization on Nursing Home Staffing
BACKGROUND: Standardization in production is common in multientity chain organizations. Although chains are prominent in the nursing home sector, standardization in care has not been studied. One way nursing home chains may standardize is by controlling the level and mix of staffing in member homes. OBJECTIVES: To examine the extent to which standardization occurred in staffing, its relative presence across different types of chains, and whether …
Consumer Decision-Making Abilities and Long-Term Care Insurance Purchase
Consumer decision-making abilities, specifically cognitive capacity, are an important determinant of LTCi decision outcomes. Deficits in this ability may prevent individuals from successfully preparing for future long-term care expenses. Policy makers should consider changes that reduce the cognitive burden of this choice, including the standardization of the LTCi market, the provision of consumer decision aids, and alternatives to voluntary and …
Real-World Data
As real-world data (RWD) in health care begin to cross over to the Big Data realms, a panel of health economists was gathered to establish how well the current US policy environment further the goals of RWD and, if not, what can be done to improve matters. This report summarizes these discussions spanning the current US landscape of RWD availability and usefulness, private versus public development of RWD assets, the current inherent bias in term…
Real-World Data
Basu, Anirban PhD*; Axelsen, Kirsten MS†; Grabowski, David C. PhD‡; Meltzer, David O. MD, PhD§; Polsky, Daniel PhD∥; Ridley, David B. PhD¶; Wiederkehr, Daniel MPh†; Philipson, Tomas J. PhD# Author Information
Do Nursing Home Chain Size and Proprietary Status Affect Experiences With Care
BACKGROUND: In 2012, over half of nursing homes were operated by corporate chains. Facilities owned by the largest for-profit chains were reported to have lower quality of care. However, it is unknown how nursing home chain ownerships are related with experiences of care. OBJECTIVES: To study the relationship between nursing home chain characteristics (chain size and profit status) with patients' family member reported ratings on experiences with…
Impacts of Unionization on Quality and Productivity
Using a regression discontinuity design, the authors of this article examine the effects of nursing home unionization on several labor, establishment, and consumer outcomes. They find negative effects of unionization on staffing levels and no decline in care quality, suggesting positive labor productivity effects. Some evidence suggests that nursing homes in less competitive local product markets and those with lower union density at the time of …
The Quality of Advanced Dementia Care in the Nursing Home
BACKGROUND: The quality of nursing home care for residents with advanced dementia has been described as suboptimal. One relatively understudied factor is the impact of special care units (SCUs) for dementia for residents at the end stage of this disease. OBJECTIVE: To examine the association between residence in an SCU and the quality of end-of-life care for nursing home residents with advanced dementia. RESEARCH DESIGN: This study used longitudi…
Gasoline prices and motor vehicle fatalities
Fatal motor vehicle crashes per capita remained relatively stable over the 1990s, in spite of new traffic safety laws and vehicle innovations. One explanation for this stability is that the price of gasoline declined, which resulted in more vehicle miles traveled and potentially more fatalities. By using 1983–2000 monthly gasoline price and fatality panel data and fixed effects specifications, this study exploits within‐state variation over time …
Does an Increase in the Medicaid Reimbursement Rate Improve Nursing Home Quality
This study supports recent trends suggesting that nursing home CON laws may be lessening in importance for the nursing home market. Nevertheless, further work is necessary to determine the quality returns to increased Medicaid reimbursement
Impacts of Unionization on Quality and Productivity
Using a regression discontinuity design, the authors of this article examine the effects of nursing home unionization on several labor, establishment, and consumer outcomes. They find negative effects of unionization on staffing levels and no decline in care quality, suggesting positive labor productivity effects. Some evidence suggests that nursing homes in less competitive local product markets and those with lower union density at the time of …
Caregiving across generations
Consumer Decision-Making Abilities and Long-Term Care Insurance Purchase
Consumer decision-making abilities, specifically cognitive capacity, are an important determinant of LTCi decision outcomes. Deficits in this ability may prevent individuals from successfully preparing for future long-term care expenses. Policy makers should consider changes that reduce the cognitive burden of this choice, including the standardization of the LTCi market, the provision of consumer decision aids, and alternatives to voluntary and …
Effect of Educational Level and Minority Status on Nursing Home Choice After Hospital Discharge
Objectives. The movement to publicly report data on provider quality to inform consumer choices is predicated on assumptions of equal access and knowledge. We examine the validity of this assumption by testing whether minority/less educated Medicare patients are at greater risk of being discharged from a hospital to the lowest-quality nursing homes in a geographic area. Methods. We used the 2002 national Minimum Data Set to identify 62601 new Med…
Does an Increase in the Medicaid Reimbursement Rate Improve Nursing Home Quality
This study supports recent trends suggesting that nursing home CON laws may be lessening in importance for the nursing home market. Nevertheless, further work is necessary to determine the quality returns to increased Medicaid reimbursement
The Economic Implications of Case-Mix Medicaid Reimbursement for Nursing Home Care
In recent years, there has been large growth in the nursing home industry in the use of case-mix adjusted Medicaid payment systems that employ resident characteristics to predict the relative use of resources in setting payment levels. Little attention has been paid to the access and quality incentives that these systems provide in the presence of excess demand conditions due to certificate-of-need (CON) and construction moratoria. Using 1991 to …
The Effects of CON Repeal on Medicaid Nursing Home and Long-Term Care Expenditures
Certificate-of-need (CON) and construction moratorium laws are used widely by states as a potential mechanism for constraining Medicaid nursing home expenditures. However, there is only limited empirical work examining whether these policies are effective at lowering Medicaid spending. Using aggregate state-level data from 1981 through 1998, this study found that states that repealed their CON and moratorium laws had no significant growth in eith…
Gasoline prices and motor vehicle fatalities
Fatal motor vehicle crashes per capita remained relatively stable over the 1990s, in spite of new traffic safety laws and vehicle innovations. One explanation for this stability is that the price of gasoline declined, which resulted in more vehicle miles traveled and potentially more fatalities. By using 1983–2000 monthly gasoline price and fatality panel data and fixed effects specifications, this study exploits within‐state variation over time …
The Admission of Blacks to High-Deficiency Nursing Homes
BACKGROUND: Although the presence of racial and ethnic disparities in nursing home care has been established, there is no work to date examining the relationship between race and government-cited nursing home deficiencies. Deficiencies are evaluations of poor quality made by state surveyors under the federal nursing home certification regulations. OBJECTIVE: The objective of this study was to examine whether blacks and other minority elders are d…
Consumer Complaints and Nursing Home Quality
From the Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts. Reprints: David C. Grabowski, PhD, Department of Health Care Policy, 180 Longwood Avenue, Boston, MA 02115-5899. Email: [email protected]
Graduated Drivers License Programs and Rural Teenage Motor Vehicle Fatalities
Context: Graduated drivers license (GDL) programs have been shown to reduce motor vehicle fatalities among 15‐ to 17‐year‐olds. However, the 20 most rural states have been the least likely to enact more stringent GDL policies. Purpose: Estimate the relationship of GDL programs and the number of traffic fatalities among 15‐ to 17‐year‐olds on rural interstate and noninterstate roadways. Methods: Analysis of 1992‐2002 Fatality Analysis Reporting Sy…
The Influence of Medicare Home Health Payment Incentives
During the late 1990s, the U.S. government instituted an interim payment system (IPS) to constrain Medicare home health care expenditures. Previous research has focused largely on the implications of the IPS for Medicare patients; this study broadens the analysis to consider patients with other payer sources. Using the National Home and Hospice Care Survey, we found similar effects of the IPS across payer types. Specifically, the IPS was associat…
Effect of Educational Level and Minority Status on Nursing Home Choice After Hospital Discharge
Objectives. The movement to publicly report data on provider quality to inform consumer choices is predicated on assumptions of equal access and knowledge. We examine the validity of this assumption by testing whether minority/less educated Medicare patients are at greater risk of being discharged from a hospital to the lowest-quality nursing homes in a geographic area. Methods. We used the 2002 national Minimum Data Set to identify 62601 new Med…
Nursing Home Quality as a Common Good
A long-standing assumption among economists is that nursing home quality is common across Medicaid and private-pay patients within a shared facility. However, there has been only limited empirical work addressing this issue. Using a unique individual level panel of residents of nursing homes from seven states, we exploit both within-facility and within-person variation in payer source and quality to examine this issue. We also test the robustness…
Medicaid Payment Rates, Case-Mix Reimbursement, and Nursing Home Staffing—1996-2004
OBJECTIVE: We examined the impact of state Medicaid payment rates and case-mix reimbursement on direct care staffing levels in US nursing homes. METHODS: We used a recent time series of national nursing home data from the Online Survey Certification and Reporting system for 1996-2004, merged with annual state Medicaid payment rates and case-mix reimbursement information. A 5-category response measure of total staffing levels was defined according…
Effect of Medicare Home Health Care Payment on Informal Care
This paper assesses the effect of payment caps for Medicare home health care on the use of informal care by older adults with functional limitations. We find that individuals exposed to more restrictive payment caps offset reductions in Medicare home health care with increased informal care, although we only observe this effect for lower-income individuals. This suggests that home care payment restrictions may have increased the caregiving burden…
Family Oversight and the Quality of Nursing Home Care for Residents With Advanced Dementia
BACKGROUND: The quality of nursing home (NH) care for residents with advanced dementia has been described as suboptimal. One relatively understudied factor in the provision of NH care is the role of private oversight and monitoring by family members and friends. OBJECTIVE: To examine the association between private oversight and the quality of end-of-life care for NH residents with advanced dementia. RESEARCH DESIGN: This study employed longitudi…
Annual Expenditures for Nursing Home Care
Background: Long-term nursing home care is primarily funded by out-of-pocket payments and public Medicaid programs. Few studies have explored price growth in nursing home care, particularly trends in the real cost of a year spent in a nursing home. Objectives: To evaluate changes in private and public prices for annual nursing home care from 1977 to 2004, and to compare nursing home price growth to overall price growth and growth in the price of …
The Effects of the Balanced Budget Act of 1997 on Home Health and Hospice in Older Adult Cancer Patients
BACKGROUND: Home health and hospice services can constitute important elements in the continuum of care for older adults diagnosed with cancer. The Balanced Budget Act (BBA) of 1997 included provisions affecting those services. OBJECTIVES: The first objective of this study is to assess the effect of the BBA of 1997 on home health and hospice service utilization in older cancer patients. The second objective is to estimate the effect of the BBA of…
Trends in Unionization of Nursing Homes
Unionization may have important implications for the delivery of nursing home care, but little is known about this phenomenon. Since 1985, the proportion of nursing home workers covered by union contracts declined from 14.6% to 9.9%. The first national-scale data on facility-level unionization reveals that unions are more common in nursing homes with more residents, in hospital-based or chain-affiliated facilities, and in facilities serving a hig…
Nursing Home Report Cards
From the *Department of Health Care Policy, Harvard Medical School, Boston, MA. I am grateful to my colleague David Stevenson for providing comments on an earlier version of this editorial. Reprints: David C. Grabowski, PhD, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115. E-mail: [email protected]
Income and the utilization of long-term care services
This paper estimates the impact of income on the long-term care utilization of elderly Americans using a natural experiment that led otherwise similar retirees to receive significantly different Social Security payments based on their year of birth. Using data from the 1993 and 1995 waves of the AHEAD, we estimate instrumental variables models and find that a positive permanent income shock lowers nursing home use but increases the utilization of…
Early Evidence on the Quality of Care Provided by Special Needs Plans
BACKGROUND: Medicare Advantage special needs plans (SNPs) have grown significantly over the past 7 years, but patient outcomes have only recently been publicly reported. METHODS: Reporting rates and scores on 4 publicly reported Healthcare Effectiveness Data and Information Set (HEDIS) measures of 697 SNPs in 2008 are examined, as are SNP characteristics associated with reporting HEDIS scores. RESULTS: SNP participation increased from 11 plans se…
The Quality of Advanced Dementia Care in the Nursing Home
BACKGROUND: The quality of nursing home care for residents with advanced dementia has been described as suboptimal. One relatively understudied factor is the impact of special care units (SCUs) for dementia for residents at the end stage of this disease. OBJECTIVE: To examine the association between residence in an SCU and the quality of end-of-life care for nursing home residents with advanced dementia. RESEARCH DESIGN: This study used longitudi…
Impacts of Unionization on Quality and Productivity
Using a regression discontinuity design, the authors of this article examine the effects of nursing home unionization on several labor, establishment, and consumer outcomes. They find negative effects of unionization on staffing levels and no decline in care quality, suggesting positive labor productivity effects. Some evidence suggests that nursing homes in less competitive local product markets and those with lower union density at the time of …
Real-World Data
As real-world data (RWD) in health care begin to cross over to the Big Data realms, a panel of health economists was gathered to establish how well the current US policy environment further the goals of RWD and, if not, what can be done to improve matters. This report summarizes these discussions spanning the current US landscape of RWD availability and usefulness, private versus public development of RWD assets, the current inherent bias in term…
Real-World Data
Basu, Anirban PhD*; Axelsen, Kirsten MS†; Grabowski, David C. PhD‡; Meltzer, David O. MD, PhD§; Polsky, Daniel PhD∥; Ridley, David B. PhD¶; Wiederkehr, Daniel MPh†; Philipson, Tomas J. PhD# Author Information
Do Nursing Home Chain Size and Proprietary Status Affect Experiences With Care
BACKGROUND: In 2012, over half of nursing homes were operated by corporate chains. Facilities owned by the largest for-profit chains were reported to have lower quality of care. However, it is unknown how nursing home chain ownerships are related with experiences of care. OBJECTIVES: To study the relationship between nursing home chain characteristics (chain size and profit status) with patients' family member reported ratings on experiences with…
Consumer Decision-Making Abilities and Long-Term Care Insurance Purchase
Consumer decision-making abilities, specifically cognitive capacity, are an important determinant of LTCi decision outcomes. Deficits in this ability may prevent individuals from successfully preparing for future long-term care expenses. Policy makers should consider changes that reduce the cognitive burden of this choice, including the standardization of the LTCi market, the provision of consumer decision aids, and alternatives to voluntary and …
Medicine (38 obras) · Geriatric Care and Nursing Homes (32 obras) · Nursing (26 obras) · Health care (22 obras) · Nursing homes (21 obras) · Business (19 obras) · Economics (16 obras) · Family medicine (15 obras) · Healthcare Policy and Management (15 obras) · Political science (14 obras)