All ETDs from UAB

Advisory Committee Chair

Robert Weech-Maldonado

Advisory Committee Members

Bisakha Sen

Ferhat Zengul

Justin L Blackburn

Larry Hearld

Rita Jablonski-Jaudon

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions


This three-paper dissertation examined the organizational and market factors predicting the response of hospital-based skilled nursing facilities (HBSNFs) to the changes in their environment such as the implementation of prospective payment system in 1998 and their role in coordination of care for patients in transition from acute care to home or a post-acute care facility. In the first study, population ecology of organizations framework was used to evaluate the organizational and market factors associated with HBSNFs’ closure after 1998. The event histories of all acute-care hospitals which had an open HBSNF in 1998 were examined across 15 years (1998-2012) to estimate their time-to-closure, adjusting for covariates. The results showed that large, not-for-profit hospitals and those located in more competitive markets had lower odds of closing their HBSNFs. The second paper focused on the association between presence of HBSNFs and hospitals’ readmission rates for congestive heart failure, acute myocardial infarction and pneumonia, using the concept of vertical integration and Resource-based view (RBV). Panel data from 2006 to 2012 was analyzed using the Ordinary Least Squares regression and a fixed effects regression with standard error correction at the hospital level. The results of the ordinary least squares regression showed a significant, negative association between the presence of HBSNFs and the overall variation in hospitals’ readmission rates. However, the fixed effects regression results did not show a similar association. The third study explored the association between HBSNFs’ staffing patterns and their health inspections and quality ratings. Logistic regression with state and year fixed effects, and standard error correction at the HBSNF level was done using panel data (2008-2011). The results showed that greater staffing mix and higher staffing intensity in terms of licensed practical nurse hours per resident day were significantly associated with high health inspections ratings and high quality ratings respectively. Given the increasing emphasis on coordination of patient care between providers, findings of this dissertation can contribute to the literature on care coordination by providing insights into the role HBSNFs could play in the patients’ transition from acute to post-acute settings and assist hospitals in improving their quality outcomes.



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.