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Background: Government regulation is intended to enhance quality, safety, fairness, or competition in the regulated industry. Such regulation entails both direct and indirect costs. Objectives: To estimate the costs associated with the regulation of quality of the nursing home industry. Sample: This study includes 11,168 free-standing nursing homes nationally, between 2004 and 2006. Research Design: Data included information from the Medicare cost reports, Minimum Data Set, Medicare Denominator file, OSCAR, and a survey of States' Certification and Licensing Offices conducted by the authors. These data were used to create variables measuring nursing homes costs, outputs, wages, competition, adjusted deficiency citations, ownership, state-fixed effects, and an index of each state's regulatory stringency. We estimated hybrid cost functions which included the regulatory stringency index. Results: The estimated cost functions demonstrated the typical behavior expected of nursing home cost functions. The stringency index was positively and significantly associated with costs, indicating that nursing homes located in states with more stringent regulatory requirements face higher costs, ceteris paribus. The average incremental costs of a 1 standard deviation increase in the stringency index resulted in a 1.1% increase in costs. Conclusions: This study for the first time places a price tag on the regulation of quality in nursing homes. It offers an order of magnitude on the costs to the industry of complying with the current set of standards and given the current level of enforcement. Complementary studies of the benefits that these regulations entail are needed to gain a comprehensive assessment of the effect of the regulation.

Many hog farmers are now suffering from high pig mortality rates due to various wasting diseases and increased breeding costs, etc. It is therefore necessary for hog farms to implement systematic and scientific pig production technology to increase productivity and produce high quality pork in order to solve these problems. In this study, we describe such a technology by suggesting a ubiquitous hog farm system which applies WSN (Wireless Sensor Network) technology to the pig industry. We suggest that a WSN and CCTV (Closed-circuit television) should be installed on hog farms to collect environmental and image information which shall then help producers not only in monitoring the hog farm via the Web from outside the farm, but also facilitate the control of hog farm facilities in remote locations. In addition, facilities can be automatically controlled based on breeding environment parameters which are already set up and a SMS notice service to notify of deviations shall provide users with convenience. Hog farmers may increase production and improve pork quality through this ubiquitous hog farm system and prepare a database with information collected from environmental factors and the hog farm control devices, which is expected to provide information needed to design and implement suitable control strategies for hog farm operation.

The use of annual hospital performance data to check a hospital's performance against the Care Quality Commission's (CQC) 16 standards. Its potential as a tool for predicting which trusts may be in danger of serious failure is considered. 0 references

The rise in assisted living facilities (ALFs), coupled with residents with increasingly complex conditions, leads to unanticipated problems linked to medication management. The purpose of this study was to describe one western state's scope of medication-related problems, the relationship of problems to facility characteristics, and the nature of the problems using state surveyors' reports from routine inspections and complaint investigations. Of the 1,335 ALFs surveyed for 2007–2008, 61.8% received a medication-related citation. Of the 1,558 allegations, 60.3% involved individual residents, with 25.2% of these being medication related. The variability in state regulations obscures an accurate understanding of the problem. Complex medication regimens delivered by unlicensed assistive personnel place residents at risk for negative health consequences. More nursing oversight is critically needed to ensure the health and safety of the new generation of ALF residents.

Two regulatory initiatives weigh heavily on the nursing workforce: establishing minimum patient-to-nurse staffing ratios in hospitals and payment policy that eliminates payment to hospitals for negative consequences of care. Although the majority of RNs favor ratios, results also indicate that a good number of RNs either do not support ratios or are unsure, which suggests that while strong support for ratios exists, the support is not universal. With regard to the Centers for Medicare and Medicaid Services hospital payment regulations, while many RNs expect that this policy change will increase the emphasis on prevention and additional education and training, RNs also believe they will be blamed if adverse patient conditions occur. A clear majority think that their work will increase, and only a small percentage of RNs think the regulations will lead to added respect, more staffing, higher pay, or raise their status. Beyond affecting the clinical environment, both regulations will impact RNs' economic value in the eyes of the hospitals that employ them.

Nine of these are identified as posing the highest risk under the commission's \"intelligent monitoring system,\" which uses data from 150 performance indicators, including feedback from patients, death rates, and staff surveys. 1 The trusts to be inspected also include some already inspected by Bruce Keogh, the NHS's medical director, on the basis of their high mortality scores, 2 and some aspirant foundation trusts that the regulator of these trusts, Monitor, has asked the commission to take a closer look at. Eight mental health trusts and community health services will also be inspected, not because they are considered to be at high risk but to help the commission test and develop the way it will inspect and regulate these types of trust. University Hospitals of Leicester Trust Aintree University Hospital Foundation Trust Heatherwood and Wexham Park Hospitals Foundation Trust Northampton General Hospital Trust Leeds Teaching Hospital Trust Royal Berkshire Foundation Trust Homerton University Hospital Foundation Trust Basildon and Thurrock University Hospitals Foundation Trust (already inspected by Keogh), and Buckinghamshire Healthcare Trust (already inspected by Keogh).

An independent commission to consider the future of health and social care in England has been set up by the health think tank the King's Fund, which aims to publish the findings in time for the 2015 general election. Given that no more resources are likely to be available, how can a system (the NHS) that rejects co-funding by the service and its users as contrary to its principles be merged with one (social care) that is based on co-funding and in which the bulk of spending comes from individuals, not the public purse? Mark Pearson of the Organisation for Economic Co-operation and Development will advise on international experience, and Nick Timmins, former public policy editor of the Financial Times, will act as rapporteur. 1 Iacobucci G. Labour proposes scheme to merge health and social care.

Recent controversies over the protection of human subjects, payment of physicians for recruiting patients to clinical trials, Food and Drug Administration (FDA) removal of approved drugs from the market, and reporting of results of clinical trials have highlighted important facets of clinical research. Less visible has been the industrialization of clinical research, and especially of clinical trials, that is, its emergence as a \"line of business\" of substantial magnitude and rapid growth. The growth of drug-industry outsourcing of clinical trials and the concomitant rise of a contract research industry are described in this paper, which argues for greater transparency in the conduct of both publicly and privately sponsored clinical trials.

Although health care institutions may resist the influence of network computing, eventually the Internet is likely to accelerate the \"virtualization\" of health care plans and systems and help to eliminate much of the clerical burden in caregiving and insurance. The core processes in health care - interactions between patients and physicians - are likely to be rapidly and profoundly affected. The greatest barrier to realizing network computing's full potential is the same barrier that has hampered the spread of enterprise computing: persuading physicians to use these technologies. Regulatory issues and cost issues also are discussed.

Persistent or chronic pain is frequently reported by older adults and has the potential to dramatically influence quality of life. Estimates indicate that 25% to 50% of community-dwelling older adults experience this kind of pain. This rate is even higher in long-term care facilities, where 50% to 75% of residents have chronic pain syndromes that are untreated or undertreated. To promote optimal pain management and enumerate the responsibilities of skilled nursing facilities to effectively treat and prevent pain, the Centers for Medicare & Medicaid Services released a new pain management surveyor guidance, F-Tag 309, which endorses the presence of an interdisciplinary team approach to pain management that involves the resident. The guidance delineates pain management principles, the need for ongoing professional education in all components of pain management, and emphasizes the important role of appropriate pharmacological treatment in conjunction with nonpharmacological interventions to aggressively manage pain. This directive will help skilled nursing facilities achieve optimal pain management for their residents.