Physicians in nursing homes: effectiveness of physician accountability and communication

The objective of this study was to develop a measure of the perceptions of nursing home (NH) directors of nursing (DONs) on the adequacy of physician care and to examine its variation as well as its construct validity.

A nationwide cross-sectional study with primary data collection.

A total of 2043 NHs surveyed between August 2009 and April 2011.

DONs and NH administrators responded to questions pertaining to their perceptions of the care provided by physicians in their NH.

Ten items were used to create 3 domains: medical staff attentiveness, physician communication, and staff concerns about physician practice. These were combined into an overall summary score measure called "Effectiveness of Physician Accountability and Communication" (EPAC). EPAC construct validity was ascertained from other DON questions and from a complementary survey of NH administrators.

The established EPAC score is the first measure to capture specific components of the adequacy of physician care in NHs. EPAC exhibited good construct validity: more effective practices were correlated with greater physician involvement in discussions of do-not-resuscitate orders, the frequency with which the medical director checked on the medical care delivered by the attending physician, the tightness of the NH's control of its physician resources, and the DON's perception of whether or not avoidable hospitalizations and emergency room visits could be reduced with greater physician attention to resident needs.

As increased attention is given to the quality of care provided to vulnerable elders, effective measures of processes of care are essential. The EPAC measure provides an important new metric that can be used in these efforts. The goal is that future studies could use EPAC and its individual domains to shed light on the manner through which physician presence is related to resident outcomes in the NH setting.