Volume 53 | Number 5 | October 2018

Abstract List

James F. Burgess Ph.D., Michael Shwartz Ph.D., Kelly Stolzmann M.S., Jennifer L. Sullivan Ph.D.


To examine the relationship between cost and quality in Veterans Health Administration () nursing homes (called Community Living Centers, s) using longitudinal data.

Data Sources/Study Setting

One hundred and thirty s over 13 quarters (from 2009 to 2012) were studied. Costs, resident days, and resident severity (s score) were obtained from the Managerial Cost Accounting System. Clinical quality measures were obtained from the Minimum Data Set, and resident‐centered care () was measured using the Artifacts of Culture Change Tool.

Study Design

We used a generalized estimating equation model with facilities included as fixed effects to examine the relationship between total cost and quality after controlling for resident days and severity. The model included linear and squared terms for all independent variables and interactions with resident days.

Principal Findings

With the exception of , all other variables had a statistically significant relationship with total costs. For most poorer performing smaller facilities (lower size quartile), improvements in quality were associated with higher costs. For most larger facilities, improvements in quality were associated with lower costs.


The relationship between cost and quality depends on facility size and current level of performance.