shareholders also must be served.
The project began to take shape when it appeared the answers might lie in public documents — particularly nursing home inspection data from the Health Care Financing Administration and financial information from the Securities and Exchange Commission.
Comparison standards
We acquired the OSCAR database for Florida from HCFA in ASCII on diskettes and imported the data into Access. Then came the requisite cleanup and false starts associated with unfamiliar data. Because our objective was to measure the homes of the six largest public companies against each other and against all other homes, the first step was to ensure accuracy in the field containing ownership information. Often that information was out of date. We used state and company documents to make revisions where necessary. This step is crucial.
Ownership changes among some homes owned by the Big Six companies dictated that we look only at one year's inspection data. The universe became 642 nursing homes whose most recent inspections occurred between January 1997 and May 1998.
We chose to look at total deficiencies as an overall indication of quality. But we were most interested in severe deficiencies that endangered or harmed patients. A field in OSCAR that assigned a letter-code ranking to each deficiency made that easy.
How to compare the homes? Should comparisons be based upon numbers of beds or numbers of homes? After careful consideration, we settled on comparing deficiency rates based on numbers of homes because of varying bed-occupancy rates and an inspection system that uses the same size sample regardless of home size. Also, comparisons based on numbers of homes would be easier for readers to grasp.
A "deficiency" is any violation of a nursing home rule or regulation. A total deficiency rate and a severe deficiency rate (both per 10 homes) were calculated for each of the Big Six companies; for all other Florida nursing homes; for all other for-profit homes; and for all nonprofit homes.
What we found
The Tribune's computer analysis found that residents of the homes operated by the Big Six companies are about 20 percent more likely to be harmed or put at risk than are residents of all other Florida nursing homes. It also showed that quality of care varied greatly among the big chains — when compared both to each other and to all other homes.
Key questions became obvious: Do large, publicly traded nursing-home corporations take better or worse care of residents than other home operators? What role, if any, does the pursuit of profit play in the equation?
With that key finding in hand — and reams of computer data on the care records of individual homes — Peterson and Tribune medical reporter Vickie Chachere descended on public records repositories around the state gathering the details that would put the flesh on the computer-constructed skeleton. They combed through thousands of pages of paper records, which held the human detail. Hundreds of interviews followed. Countless hours were spent in nursing homes. The SEC's EDGAR database and the companies' own Web sites provided financial context.
Published as a special 8-page section on Nov. 15, the project struck a chord with readers and with lawmakers. Moderated by executive editor Gil Thelen, a community forum on a weeknight just before the holidays brought 150 people to the newspaper's downtown offices. State and federal lawmakers filed reform bills. Published during the midst of a change in administrations at the state level, the real impact of the project won't be felt until after the legislative session.
Doug Stanley can be reached at (813) 259-7364 or by e-mail at dstanley@tampatrib.com