R53,

No abstract

A report published last year by the Centers for Medicare & Medicaid Services (CMS) highlighted that COVID-19 case counts are more likely to be high in lower quality nursing homes than in higher quality ones. Since then, multiple studies have examined this association with a handful also exploring the role of facility quality in explaining resident deaths from the virus. Despite this wide interest, no previous study has investigated how the relation between quality and COVID-19 mortality among nursing home residents may have changed, if at all, over the progression of the pandemic. This understanding is indeed lacking given that prior studies are either cross-sectional or are analyses limited to one specific state or region of the country. To address this gap, we analyzed changes in nursing home resident deaths across the US between June 1, 2020 and January 31, 2021 (n = 12,415 nursing homes X 8 months) using both descriptive and multivariable statistics. We merged publicly available data from multiple federal agencies with mortality rate (per 100,000 residents) as the outcome and CMS 5-star quality rating as the primary explanatory variable of interest. Covariates, based on the prior literature, consisted of both facility- and community-level characteristics. Findings from our secondary analysis provide robust evidence of the association between nursing home quality and resident deaths due to the virus diminishing over time. In connection, we discuss plausible reasons, especially duration of staff shortages, that over time might have played a critical role in driving the quality-mortality convergence across nursing homes in the US.

Business support programs, represented by small business development centers (SBDCs), business incubators and Small Business Innovation Research grants (SBIRs), play an important role in assisting new or small firms, nurturing entrepreneurial culture, and facilitating regional growth. Previous studies have found that the presence of business incubators in a region is positively associated with the level of agglomeration and negatively associated with the level of business development. It is however unclear whether the local knowledge context may influence the local presence of SBDCs, business incubators or SBIRs. This paper examines the role of knowledge in shaping the geography of US business support programs using county-level data.

A small but growing body of empirical research underscores the relationship between a city's status as a political capital and its status within an urban hierarchy. Both theoretical and empirical work has attributed this to the agglomeration effects of government activity in the capital. The hypothesis of this paper is that this agglomeration is driven by distance-based transaction costs of oversight. This hypothesis is tested using a sample of U.S. metropolitan statistical areas for the years 2001-2008. The results are consistent with the hypothesis. Specifically, the empirical results indicate that greater distance from the capital is related to lower levels of government employment and expenditure per government employee among noncapital metropolitan areas.