Abstract
Objectives
To characterize the practice profile of nursing home (NH) physicians in Ontario, Canada.
Design
Population-based cross-sectional study.
Setting and Participants
A total of 1527 most responsible physicians (MRPs) across 626 NHs in Ontario, Canada,
for the calendar year, 2017.
Methods
We examined physician services within all publicly regulated and funded NH facilities.
Descriptive summaries were generated to characterize MRPs and their practice patterns
by the physician's primary practice location, the NH facility size, and the proportion
of physician billings that occurred within NHs. Community sizes were classified into
quintiles based on population size and assigned as urban or rural. The number of ministry-designated
NH beds were assessed by quintiles to examine physician services by facility size.
We also assessed the proportion of physician billings within NHs by quintiles.
Results
MRPs tended to be older, male, and practice family medicine. The majority of MRPs
practiced in communities with populations exceeding 100,000 residents, although physicians
with greater NH billings tended to practice in rural locations. The mean number of
NH residents that a physician was MRP for was positively associated with the community
size. Physicians provided care for more NH residents than they were assigned most
responsible. Fifty-one percent of physicians were MRP for 90% of all NH residents.
Conclusions and Implications
Our work provides an exemplar for characterizing physician commitment in NHs, using
2 approaches, according to the NH specialist model. We demonstrated the medical practice
characteristics, locations, and billing patterns of physicians within Ontario NHs.
Future work can investigate the association between physician commitment and the quality
of care provided to NH residents. A greater understanding of physician commitment
may lead to the development of quality metrics based on physician practice patterns.
Keywords
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References
- What exactly is an “SNF-ist?”.JAMA Intern Med. 2018; 178: 153
- Association between proportion of provider clinical effort in nursing homes and potentially avoidable hospitalizations and medical costs of nursing home residents.J Am Geriatr Soc. 2013; 61: 1750-1757
- The nursing home physician workforce.J Am Med Dir Assoc. 2006; 7: 394-398
- Experts recommend minimum nurse staffing standards for nursing facilities in the United States.The Gerontologist. 2000; 40: 5-16
- medical care delivery in US nursing homes: current and future practice.The Gerontologist. 2021; 61: 595-604
- Postacute care outcomes and Medicare payments for patients treated by physicians and advanced practitioners who specialize in nursing home practice.Health Serv Res. 2019; 54: 564-574
- Medical practice with nursing home residents: results from the National Physician Professional Activities Census.J Am Geriatr Soc. 1997; 45: 911-917
- Temporal trends in the numbers of skilled nursing facility specialists from 2007 through 2014.JAMA Intern Med. 2017; 177: 1376
- Characterizing physician practice in nursing homes using claims-based measures: correlation with nursing home administrators’ perceptions.Med Care Res Rev. 2020; 78: 806-815
- Assessing first visits by physicians to Medicare patients discharged to skilled nursing facilities.Health Aff (Millwood). 2019; 38: 528-536
- Nursing home physician specialists: a response to the workforce crisis in long-term care.Ann Intern Med. 2009; 150: 411
- Physician visits at the nursing home: does more mean better care?.J Am Med Dir Assoc. 2019; 20: 653-654
- Family physicians providing regular care to residents in Ontario long-term care homes.Can Fam Phys. 2012; 58: 1241
- Physicians and advanced practitioners specializing in nursing home care, 2012‒2015.JAMA. 2017; 318: 2040
- Defining and measuring quality outcomes in long-term care.J Am Med Dir Assoc. 2007; 8: e129-e137
- Increasing complexity of new nursing home residents in Ontario, Canada: a serial cross-sectional study.J Am Geriatr Soc. 2020; 68: 1293-1300
- Exploring variation in rates of polypharmacy across long term care homes.J Am Med Dir Assoc. 2012; 13: 309.e15-309.e21
- Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration.PLoS Med. 2007; 4: e297
- Postal CodeOM Conversion File (PCCF) Reference Guide.Statistics Canada, 2017 (92-154-G)
- An evaluation of data quality in Canada's Continuing Care Reporting System (CCRS): secondary analyses of Ontario data submitted between 1996 and 2011.BMC Med Inform Decis Mak. 2013; 13: 27
- Resident Assessment Instrument (RAI) RAI-MDS 2.0 User's Manual, Canadian Version.interRAI, 2010
- Physician availability in long-term care and resident hospital transfer: a retrospective cohort study.J Am Med Dir Assoc. 2019; 21: 469-475
- Physician practice patterns in nursing homes.J Am Med Dir Assoc. 2007; 8: 558-567
- Schedule of Benefits Under the Health Insurance Act.Government of Ontario, 2021https://www.health.gov.on.ca/en/pro/programs/ohip/sob/Date accessed: June 15, 2021
- Doctors in Hospitals: Medical Staff Organization and Hospital Performance.Johns Hopkins University Press, 1971
- The Effects of Management Practices on Hospital Efficiency and Quality of Care.Blue Cross Assoc, 1976 (Organizational Research in Hospitals)
- An empirical assessment of high-performing medical groups: results from a national study.Med Care Res Rev. 2005; 62: 407-434
- Physician staffing patterns correlates of nursing home care: an initial inquiry and consideration of policy implications.J Am Geriatr Soc. 1994; 42: 787-793
- Nursing home medical staff organization: correlates with quality indicators.J Am Med Dir Assoc. 2011; 12: 655-659
- Is there a future for nursing homes in Canada?.Healthc Manage Forum. 2021; 35: 17-20
- The Impact of COVID-19 on Long-Term Care in Canada: Focus on the First 6 Months.CIHI, 2021https://www.cihi.ca/sites/default/files/document/impact-covid-19-long-term-care-canada-first-6-months-report-en.pdfDate accessed: November 8, 2021
- Front-line nursing home staff experiences during the COVID-19 pandemic.J Am Med Dir Assoc. 2021; 22: 199-203
- Attending Nurse Practitioners in Long-Term Care Homes Recruitment and Integration Toolkit.Nursing Policy and Innovation Branch, 2017health.gov.on.ca/en/pro/programs/hhrsd/nursing/docs/2017_NP_LTCH_Rec_int_toolkit.pdfDate accessed: November 8, 2021
- A comparative study of nursing home resident outcomes between care provided by nurse practitioners/physicians versus physicians only.J Am Med Dir Assoc. 2004; 5: 16-23
- Family medicine profile.
- Quality indicators of primary care provider engagement in nursing home care.J Am Med Dir Assoc. 2018; 19: 824-832
Article info
Publication history
Published online: May 21, 2022
Footnotes
This work was supported partially by Schlegel Chair in Clinical Epidemiology in Aging at McMaster University, as well as the Florida State University Department of Geriatrics.
The authors declare no conflicts of interest.
Identification
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