Organizational and environmental correlates of the adoption of a focus strategy in U.S. hospices

Background: The hospice industry has experienced rapid growth in the last decade and has become a prominent component of the U.S. health care delivery system. In recent decades, the number of hospices serving nursing facility residents has increased. However, there is paucity of research on the organizational and environmental determinants of this strategic behavior. Purpose: The aimof this studywas to empirically identify the factors associatedwith the adoption of a nursing facility focus strategy in U.S. hospices. A nursing facility focus strategywas defined in this study as a strategic choice to target the provision of hospice services to skilled nursing facility or nursing home residents. Methodology/Approach: This study employed a longitudinal study design with lagged independent variables in answering its research questions. Data for the study's dependent variables are obtained for the years 2005Y2008, whereas data for the independent variables are obtained for the years 2004Y2007, representing a 1-year lag. Mixed effects regression models were used in the multivariate regression analyses. Findings: Using a resource dependence framework, the findings from this study indicate that organizational size, community wealth, competition, and ownership type are important predictors of the adoption of a nursing facility focus strategy. Practice Implications: Hospices may be adopting a nursing facility focus strategy in response to increasing competition. The decision to focus the provision of care to nursing facility residentsmay be driven by the need to secure stability in referrals. Further empirical exploration of the performance implications of adopting a nursing facility focus strategy is warranted.