This study investigated the impact of state nursing home staffing standards on nurse staffing levels for the year 2011. Specifically, the study attempted to measure state staffing standards at facility level (i.e., nurse staffing levels that each individual nursing home must retain by its state staffing standards) and analyzed the policy impact. The study findings indicated that state staffing standards for the categories of registered nurse, licensed nurse, or total nurse are positively related to registered nurse, licensed nurse, or total nurse staffing levels, respectively. Nursing homes more actively responded to licensed staffing requirements than total staffing requirements. However, nursing homes did not increase their staffing levels as much as those required by state staffing standards. It is possibly because the quality-oriented inspection allows flexibility in nursing homes' control of nurse staffing levels.

Quality of care has been a long-standing issue in US nursing homes. The culture change movement attempts to transition nursing homes from health care institutions to person-centered homes. While the adoption of culture change has been spreading across nursing homes, barriers to adoption persist. Nursing homes that disproportionately serve minority residents may have additional challenges implementing culture change compared with other facilities due to limited financial and staffing resources. The objective of this study was to examine how nursing home characteristics are associated with culture change adoption in Central Florida nursing homes. This cross-sectional study included 81 directors of nursing (DONs) who completed the Artifacts of Culture Change survey. In addition, nursing home organizational data were obtained from the Certification and Survey Provider Enhanced Reports (CASPER). A logistic regression was conducted to examine the relationship between high culture change adoption and nursing home characteristics. The overall adoption of culture change scores in Central Florida nursing homes was low. Nevertheless, there was variability across nursing homes in the adoption of culture change. High culture change adoption was associated with nursing homes having lower proportions of Medicaid residents.

Fewer than 9% of US hospitals had basic EHR systems as of 2008. The HITECH Act funded a multi-billion-dollar investment to close this gap requiring standards known as meaningful use (MU). The study was undertaken to assess whether this investment achieved the stated aims of MU; EHR adoption, lower cost and higher quality. The study is across-sectional, retrospective design; it employed two cohorts, MU vs. non-MU hospitals. Publicly reported, risk adjusted data from 4,221 hospitals (95%) on clinical, cost and safety metrics were analysed. The findings: EHR adoption by hospitals responded positively in response to incentives, rising from 8% to 55%. Quality outcomes showed 21,000 fewer deaths (p < 0.05) between the three clinical conditions (heart attack, heart failure, pneumonia). The HITECH Act had a positive return on investment with lower hospital cost per discharge of $327 (p < 0.05). The study results suggest hospitals with EHRs' that met MU standards demonstrate statistically significant mortality and cost improvement.