Defining and evaluating the impact of physician commitment to nursing home practice: a population-level cross-sectional study

Background — Medical care of complex nursing home (NH) residents in Canada is primarily managed by physicians. While physician commitment to NH practice is assumed to impact care quality, its influence on resident outcomes is inconsistent. This study quantifies commitment among NH physicians in Ontario, Canada, and its association with the quality of care among NH residents.

Methods — We conducted a retrospective cross-sectional study using multiple linked health administrative databases in 2022. We describe the practice patterns of the most responsible physician (MRP) of NH residents. We assessed three measures of commitment, including the proportion of NH practice based on residents, years in NH practice, and the number of NHs a physician worked in. Pearson-scaled Poisson and negative binomial regression models examined the relationship between commitment and resident outcomes, including medication prescriptions, emergency department (ED) visits, hospitalizations, and death.

Results — Our study identified 1368 NH MRPs practicing in 628 NHs and caring for 84,914 residents in Ontario. One hundred and fourteen (8.3%) had a ≥ 80% practice commitment to NH. The MRP cohort was generally male, had less than full-time practice, worked in more urban settings, and practiced in various settings beyond NH. We observed mixed associations between measures of commitment and resident outcomes, with some evidence suggesting that higher commitment could be beneficial. Residents receiving care from an MRP with ≥ 80% practice commitment had a reduced rate of ED visits (RR 0.90; 95% CI 0.83–0.99).

Conclusions — Our work is the first to explore the impact of commitment in NH MRPs on resident care quality in Ontario, Canada. While commitment may be a factor, it is not the sole determinant of care quality. Further research is needed to refine how commitment is defined and measured and to consider additional factors beyond the physician, such as infrastructure, NH staff, and team collaboration, in how they influence care quality.