Impact of Medical Director Certification on Nursing Home Quality of Care

Objective: This study tests the research hypothesis that certified medical directors are able to use their training, education, and knowledge to positively influence quality of care in US nursing homes. Design: F-tag numbers were identified within the State Operations Manual that reflect dimensions of quality thought to be impacted by the medical director. A weighting system was developed based on the "scope and severity" level at which the nursing homes were cited for these specific tag numbers. Then homes led by certified medical directors were compared with homes led by medical directors not known to be certified. Data/participants: Data were obtained from the Centers for Medicare & Medicaid Services' Online Survey Certification and Reporting database for nursing homes. Homes with a certified medical director (547) were identified from the database of the American Medical Directors Association. Measurements: The national survey database was used to compute a "standardized quality score" (zero representing best possible score and 1.0 representing average score) for each home, and the homes with certified medical directors compared with the other homes in the database. Regression analysis was then used to attempt to identify the most important contributors to measured quality score differences between the homes. Results: The standardized quality score of facilities with certified medical directors (n = 547) was 0.8958 versus 1.0037 for facilities without certified medical directors (n = 15,230) (lower number represents higher quality). When nursing facility characteristics were added to the regression equation, the presence of a certified medical director accounted for up to 15% improvement in quality. Conclusions: The presence of certified medical directors is an independent predictor of quality in US nursing homes. (J Am Med Dir Assoc 2009; 10: 431-435)