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Castle NG, Gifford D, Schwartz LB. The CoreQ: Development and Testing of a Nursing Facility Resident Satisfaction Survey. J Appl Gerontol 2020; 40:629-637. [PMID: 32723121 DOI: 10.1177/0733464820940871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The development and testing of a nursing facility resident satisfaction survey (i.e., CoreQ) that could be used for public reporting purposes is presented here. This is important as very little satisfaction with care information is publicly available for nursing facility consumers. Validity testing is reported detailing the development of the CoreQ: Short Stay Discharge questionnaire and a measure that was calculated from the items in the questionnaire. This questionnaire resulted in four items whose combined score gives a measure representing participants' overall satisfaction with the nursing facility. The measure parsimoniously reports this satisfaction as a score (ranging from 0 to 100) and was recently endorsed by the National Quality Forum (NQF). The measure may have significance for report cards and payment metrics, as it incorporates the consumers' opinion.
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Affiliation(s)
- Nicholas G Castle
- West Virginia University School of Public Health (Rm 3824), Morgantown, USA
| | - David Gifford
- American Health Care Association/National Center for Assisted Living, Washington, DC, USA
| | - Lindsay B Schwartz
- American Health Care Association/National Center for Assisted Living, Washington, DC, USA
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Perceived Patient Safety Culture in Nursing Homes Associated With "Nursing Home Compare" Performance Indicators. Med Care 2019; 57:641-647. [PMID: 31259786 DOI: 10.1097/mlr.0000000000001142] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The safety and quality of care provided to nursing home residents is a significant concern. Little is known whether fostering patient safety culture helps improve the safety and quality of nursing home care. METHODS This study determined the associations of nursing home patient safety culture performance, as reported by administrators, directors of nursing, and unit leaders in a large national sample of free-standing nursing homes, with several "Nursing Home Compare" performance indicators. We conducted the survey in 2017 using the Agency for Healthcare Research and Quality Survey on Patient Safety Culture for nursing homes to collect data on 12 core domains of safety culture scores. Survey data were linked to other nursing home files for multivariable regression analyses. RESULTS Overall, 818 of the 2254 sampled nursing homes had at least 1 completed survey returned for a response rate of 36%. After adjustment for nursing home, market, and state covariates, every 10 percentage points increase in overall positive response rate for safety culture was associated with 0.56 fewer health care deficiencies (P=0.001), 0.74 fewer substantiated complaints (P=0.004), reduced fines by $2285.20 (P=0.059), and 20% increased odds of being designated as 4-star or 5-star (vs. 1 to 3 star) facilities (odds ratio roughly=1.20, P<0.05). CONCLUSIONS Efforts to improve nursing home performance in patient safety culture have the potential to improve broad safety and quality of care measures encapsulated in the Nursing Home Compare publication.
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Plaku-Alakbarova B, Punnett L, Gore RJ. Nursing Home Employee and Resident Satisfaction and Resident Care Outcomes. Saf Health Work 2018; 9:408-415. [PMID: 30559988 PMCID: PMC6284169 DOI: 10.1016/j.shaw.2017.12.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/08/2017] [Accepted: 12/09/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Nursing home resident care is an ongoing topic of public discussion, and there is great interest in improving the quality of resident care. This study investigated the association between nursing home employees' job satisfaction and residents' satisfaction with care and medical outcomes. METHODS Employee and resident satisfaction were measured by questionnaire in 175 skilled nursing facilities in the eastern United States from 2005 to 2009. Facility-level data on residents' pressure ulcers, medically unexplained weight loss, and falls were obtained from the Centers for Medicare and Medicaid Services Long-Term Care Minimum Data Set. The association between employee satisfaction and resident satisfaction was examined with multiple and multilevel linear regression. Associations between employee satisfaction and the rates of pressure ulcers, weight loss, and falls were examined with simple and multilevel Poisson regression. RESULTS A 1-point increase in overall employee satisfaction was associated with an increase of 17.4 points (scale 0-100) in the satisfaction of residents and family members (p < 0.0001) and a 19% decrease in the incidence of resident falls, weight loss, and pressure ulcers combined (p < 0.0001), after adjusting for staffing ratio and percentage of resident-days paid by Medicaid. CONCLUSION Job satisfaction of nursing home employees is associated with lower rates of resident injuries and higher resident satisfaction with care. A supportive work environment may help increase quality of care in the nation's nursing homes.
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Affiliation(s)
- Bora Plaku-Alakbarova
- Department of Work Environment & Center for the Promotion of Health in the New England Workplace (CPHNEW), University of Massachusetts Lowell, Lowell, MA, USA
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Brauner D, Werner RM, Shippee TP, Cursio J, Sharma H, Konetzka RT. Does Nursing Home Compare Reflect Patient Safety In Nursing Homes? Health Aff (Millwood) 2018; 37:1770-1778. [PMID: 30395505 PMCID: PMC6405288 DOI: 10.1377/hlthaff.2018.0721] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The past several decades have seen significant policy efforts to improve the quality of care in nursing homes, but the patient safety movement has largely ignored this setting. In this study we compared nursing homes' performance on several composite quality measures from Nursing Home Compare, the most prominent recent example of a national policy aimed at improving the quality of nursing home care, to their performance on measures of patient safety in nursing homes such as pressure sores, infections, falls, and medication errors. Although Nursing Home Compare captures some aspects of patient safety, we found the relationship to be weak and somewhat inconsistent, leaving consumers who care about patient safety with little guidance. We recommend that Nursing Home Compare be refined to provide a clearer picture of patient safety and quality of life, allowing consumers to weight these domains according to their preferences and priorities.
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Affiliation(s)
- Daniel Brauner
- Daniel Brauner is an associate professor in the Department of Medicine, University of Chicago, in Illinois
| | - Rachel M Werner
- Rachel M. Werner is a professor of medicine in the Division of General Internal Medicine at the Perelman School of Medicine and a professor of health care management at the Wharton School of Business, both at the University of Pennsylvania, and core faculty at the Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, in Philadelphia
| | - Tetyana P Shippee
- Tetyana P. Shippee is an associate professor in the Division of Health Policy and Management, School of Public Health, University of Minnesota, in Minneapolis
| | - John Cursio
- John Cursio is a research assistant professor in the Department of Public Health Sciences, University of Chicago
| | - Hari Sharma
- Hari Sharma is an assistant professor in the Department of Health Management and Policy, University of Iowa, in Iowa City. At the time this research was conducted, Sharma was a doctoral student in the Department of Public Health Sciences, University of Chicago
| | - R Tamara Konetzka
- R. Tamara Konetzka ( ) is a professor in the Department of Public Health Sciences and in the Department of Medicine, University of Chicago
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Gadbois EA, Tyler DA, Mor V. Selecting a Skilled Nursing Facility for Postacute Care: Individual and Family Perspectives. J Am Geriatr Soc 2017; 65:2459-2465. [PMID: 28682444 DOI: 10.1111/jgs.14988] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To describe individuals' experiences during the hospital discharge planning and skilled nursing facility (SNF) selection process. DESIGN Semistructured interviews focusing on discharge planning and nursing facility selection, including how facilities were chosen, who was involved, and what factors were important in decision-making. SETTING 14 SNFs in five cities across the United States. PARTICIPANTS Newly admitted, previously community-dwelling SNF residents (N = 98) and their family members. MEASUREMENT Semistructured interviews were qualitatively coded to identify underlying themes. RESULTS Most respondents reported receiving only a list of SNF names and addresses from discharge planners and that hospital staff were minimally involved. Proximity to home and prior experience with the facility most often influenced choice of SNF. Most respondents reported being satisfied with their placement, although many stated that they would have been willing to travel further to another SNF were it recommended. Many reported feeling rushed and unprepared, stating that they did not know where or how to get help. CONCLUSION SNF placement is a stressful transition, occurring when people are physically vulnerable and with limited guidance from discharge planners. Therefore, most people select a facility based on its location, perhaps because they are provided with no other information. Given Centers for Medicare and Medicaid Services' proposed changes to the discharge planning process, this research highlights the value of providing people and family caregivers with quality data and assistance in interpreting it.
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Affiliation(s)
- Emily A Gadbois
- Center for Gerontology & Healthcare Research, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island
| | - Denise A Tyler
- Center for Gerontology & Healthcare Research, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island.,RTI International, Waltham, Massachusetts
| | - Vincent Mor
- Center for Gerontology & Healthcare Research, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island
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Abstract
The purpose of this research is to examine the relationship between quality of care in nursing homes and their likelihood of closure. We hypothesize that lower-quality facilities will be more likely to close than higher-quality facilities. Using the rates of physical restraint use, urethral catheterization, contractures, pressure ulcers, and psychotropic medication use as quality measures from approximately 12,000 facilities from 1992 to 1998, the author examine cross-sectional and change score relationships between these measures and a nursing home’s likelihood of closure. The descriptive analysis shows that 621 nursing homes closed in this time period, and the results for physical restraint use were robust in their positive association with closures in most analyses lending some support for this study’s hypothesis. However, overall, the author concludes that nursing facility closures are relatively rare events. And the likelihood of closure, even for poor-quality facilities, is low.
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Hefele JG, Acevedo A, Nsiah‐Jefferson L, Bishop C, Abbas Y, Damien E, Ramos C. Choosing a Nursing Home: What Do Consumers Want to Know, and Do Preferences Vary across Race/Ethnicity? Health Serv Res 2016; 51 Suppl 2:1167-87. [PMID: 26867753 PMCID: PMC4874936 DOI: 10.1111/1475-6773.12457] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To identify what consumers want to know about nursing homes (NHs) before choosing one and to determine whether information preferences vary across race/ethnicity. DATA SOURCES/STUDY SETTING Primary data were collected in Greater Boston (January 2013-February 2014) from community-dwelling, white, black, and Latino adults aged 65+ and 40-64 years, who had personal/familial experience with a NH admission or concerns about one. STUDY DESIGN Eleven focus groups and 30 interviews were conducted separately by race/ethnicity and age group. PRINCIPAL FINDINGS Participants wanted detailed information on the facility, policies, staff, and residents, such as location, staff treatment of residents, and resident conditions. They wanted a sense of the NH gestalt and were interested in feedback/reviews from residents/families. Black and Latino participants were especially interested in resident and staff racial/ethnic concordance and facility cultural sensitivity. Latino participants wanted information on staff and resident language concordance. CONCLUSIONS Consumers want more information about NHs than what is currently available from resources like Nursing Home Compare. Report card makers can use these results to enhance their websites, and they should consider the distinct needs of different racial/ethnic groups. Future research should test methods for collecting and reporting resident and family feedback/reviews.
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Affiliation(s)
| | - Andrea Acevedo
- Heller School of Social Policy and ManagementBrandeis UniversityWalthamMA
| | | | - Christine Bishop
- Heller School of Social Policy and ManagementBrandeis UniversityWalthamMA
| | - Yasmin Abbas
- Heller School of Social Policy and ManagementBrandeis UniversityWalthamMA
| | - Ecaterina Damien
- Heller School of Social Policy and ManagementBrandeis UniversityWalthamMA
| | - Candi Ramos
- Heller School of Social Policy and ManagementBrandeis UniversityWalthamMA
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Liu D, Lu CJ. An Evaluation of Web-Based Nursing Home Finders. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2015. [DOI: 10.1080/15398285.2015.1026701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Liu D, Lu CJ. Visibility and findability of the nursing home compare website. SOCIAL WORK IN PUBLIC HEALTH 2014; 30:144-156. [PMID: 25491187 DOI: 10.1080/19371918.2014.969861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Nursing Home Compare (NHC) is a federal government website providing information for selecting a nursing home. However, not many consumers were aware of or can locate the site. This study analyzed 50 official state and District of Columbia websites from September through December 2013. Using Google "inlink:" operator, this study evaluated the visibility and findability of NHC links in each state-level website. The results show that a link to NHC is available in all states except for Connecticut, Florida, and Michigan. Although it took only 4.7 clicks on average to the page with a NHC link, consumers may still have difficulty to find NHC from a state website. This article provides a snapshot of the visibility and findability of NHC and indicates a need for further investigation of promising website dissemination strategies not yet adequately evaluated.
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Affiliation(s)
- Darren Liu
- a Department of Health Care Administration and Policy , School of Community Health Sciences, University of Nevada , Las Vegas , Nevada , USA
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Cramer ME, High R, Culross B, Conley DM, Nayar P, Nguyen AT, Ojha D. Retooling the RN workforce in long-term care: Nursing certification as a pathway to quality improvement. Geriatr Nurs 2014; 35:182-7. [DOI: 10.1016/j.gerinurse.2014.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 01/06/2014] [Accepted: 01/09/2014] [Indexed: 11/25/2022]
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Wang ML. An evaluation of customer relationship management in hospital-based and privately run nursing homes in Taiwan. TOTAL QUALITY MANAGEMENT & BUSINESS EXCELLENCE 2013. [DOI: 10.1080/14783363.2011.637783] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Walsh JE, Lane SJ, Troyer JL. Impact of Medication Aide Use on Skilled Nursing Facility Quality. THE GERONTOLOGIST 2013; 54:976-88. [DOI: 10.1093/geront/gnt085] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tokunaga M, Hashimoto H. Factors affecting the entry of for-profit providers into a price regulated market for formal long-term care services: a case study from Japan. Soc Sci Med 2012. [PMID: 23182594 DOI: 10.1016/j.socscimed.2012.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
While the distinct behaviors of for-profit and non-profit providers in the healthcare market have been compared in the economic literature, their choices regarding market entry and exit have only recently been debated. Since 2000, when public Long-Term Care Insurance was introduced in Japan, for-profit providers have been able to provide formal long-term homecare services. The aim of this study is to determine which factors have affected market entry of for-profit providers under price regulation and in competition with existing non-profit providers. We used nation-wide panel data from 2002 to 2010, aggregated at the level of local public insurers (n = 1557), a basic area unit of service provision. The number of for-profit providers per elderly population in the area unit was regressed against factors related to local demand and service costs using first-difference linear regression, a fixed effects model, and Tobit regression for robustness checking. Results showed that demand (the number of eligible care recipients) and cost factors (population density and minimum wage) significantly influenced for-profit providers' choice of market entry. These findings indicate that for-profit providers will strategically choose a local market for maximizing profit. We believe that price regulation should be redesigned to incorporate quality of care and market conditions, regardless of the profit status of the providers, to ensure equal access to efficient delivery of long-term care across all regions.
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Affiliation(s)
- Mutsumi Tokunaga
- Department of Health Economics and Epidemiology Research, The University of Tokyo, School of Public Health, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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Choi J, Flynn L, Aiken LH. Nursing practice environment and registered nurses' job satisfaction in nursing homes. THE GERONTOLOGIST 2012; 52:484-92. [PMID: 21908803 PMCID: PMC3409799 DOI: 10.1093/geront/gnr101] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Accepted: 08/03/2011] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Recruiting and retaining registered nurses (RNs) in nursing homes is problematic, and little research is available to guide efforts to make nursing homes a more attractive practice environment for RNs. The purpose of this study was to examine relationships between aspects of the nursing practice environment and job satisfaction among RNs in nursing homes. DESIGN AND METHODS The sample included 863 RNs working as staff RNs in 282 skilled nursing facilities in New Jersey. Two-level hierarchical linear modeling was used to account for the RNs nested by nursing homes. RESULTS Controlling for individual and nursing home characteristics, staff RNs' participation in facility affairs, supportive manager, and resource adequacy were positively associated with RNs' job satisfaction. Ownership status was significantly related to job satisfaction; RNs working in for-profit nursing homes were less satisfied. IMPLICATIONS A supportive practice environment is significantly associated with higher job satisfaction among RNs working in nursing homes. Unlike other nursing home characteristics, specific dimensions of the nursing practice environment can be modified through administrative actions to enhance RN job satisfaction.
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Affiliation(s)
- JiSun Choi
- National Database of Nursing Quality Indicators, School of Nursing, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
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Cox CC, Eldridge-Houser J, Hasken J, Temme M. Relationship of Facility Characteristics and Presence of an Ombudsman to Missouri Long-Term Care Facility State Inspection Report Results. J Elder Abuse Negl 2011; 23:273-88. [PMID: 27119530 DOI: 10.1080/08946566.2011.584051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study analyzes existing data describing general facility characteristics, the presence of an ombudsman in the facility, and the number of deficiencies/violations reported for long-term care facilities in the state of Missouri. The model that predicted the rate of deficiencies/violations best was one that included the following characteristics: "contained more than 50 beds" and "considered a Skilled Nursing facility." Findings suggest that the characteristics that are significantly associated with fewer deficiencies are larger size (more than 50 beds) and being classified as Skilled Nursing. While those facilities that housed an ombudsman were found to have fewer deficiencies per bed in the general analysis, further investigation found this to be an artifact mostly due to the higher rate of ombudsmen at larger facilities.
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Affiliation(s)
- Carolyn C Cox
- a Department of Health Science , Truman State University , Kirksville , Missouri , USA
| | | | - Julie Hasken
- a Department of Health Science , Truman State University , Kirksville , Missouri , USA
| | - Megan Temme
- a Department of Health Science , Truman State University , Kirksville , Missouri , USA
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Flynn L, Liang Y, Dickson GL, Aiken LH. Effects of nursing practice environments on quality outcomes in nursing homes. J Am Geriatr Soc 2010; 58:2401-6. [PMID: 21054327 PMCID: PMC3392023 DOI: 10.1111/j.1532-5415.2010.03162.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The objective of this study was to determine whether nurse staffing levels and modifiable characteristics of the nursing practice environment are associated with important quality indicators represented by the percentage of residents with pressure ulcers and numbers of deficiency citations in nursing homes. A cross-sectional design linked nurse survey data, aggregated to the facility level, with Nursing Home Compare, a publicly available federal database containing nursing home-level measures of quality. The facility sample consisted of 63 Medicare- and Medicaid-certified nursing homes in New Jersey, and the nurse survey sample comprised 340 registered nurses providing direct resident care. Characteristics of the practice environment were measured using the Practice Environment Scale of the Nursing Work Index, included in the nurse survey. The total number of deficiency citations, the percentage of residents with pressure ulcers, nurse staffing levels, and facility characteristics were extracted from the Nursing Home Compare database. Results indicated that a supportive practice environment was inversely associated with the percentage of residents with pressure ulcers and fully mediated the effect of profit status on this important outcome. The nursing practice environment and facility size explained 25% of the variance in quality deficiencies. There were no associations between staffing levels and quality indicators. Findings indicate that administrative initiatives to create environments that support nursing practice may hold promise for improving quality indicators in nursing homes.
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Affiliation(s)
- Linda Flynn
- Rutgers College of Nursing, The State University of New Jersey, Newark, New Jersey 07102, USA.
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Changes in Clinical and Hotel Expenditures Following Publication of the Nursing Home Compare Report Card. Med Care 2010; 48:869-74. [PMID: 20733531 DOI: 10.1097/mlr.0b013e3181eaf6e1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Nursing home report cards can be potentially key tools for disseminating information to consumers. However, few accounts of state-based nursing home report cards are available. In the research presented here, the scale, scope, utility, and changes over time in these nursing home report cards are described. This article finds that the number of report cards has increased from 24 in 2003 to 29 in 2009. The quality information presented varies considerably; however, deficiency citations are still the most frequently reported quality indicators. The utility of report cards varies considerably. The authors present their opinions of features that seem most conducive for consumer use of these report cards.
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Affiliation(s)
| | - Jill Diesel
- 1 University of Pittsburgh, Pittsburgh, PA, USA
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Abstract
BACKGROUND Few studies have addressed the extent to which consumers use nursing home report cards and how they use this information. These questions, which are significant because the nursing home market presents several challenges to the effectiveness of report cards, were pursued in a study. METHODS Data used in this investigation came from three mail surveys conducted in 2006 of family members of nursing home residents (N = 4,754), family members of assisted-living residents (N = 496), and elders living in high-rise buildings (N = 1,252). RESULTS Some 31% of family members of nursing home residents, 53% of family members of assisted-living residents, and 23% of elders living in high-rise buildings used the Internet in looking for a nursing home. In general, these different types of consumers look for different types of nursing home information. DISCUSSION According to the results, most consumers who used the Internet to look for a nursing home also used a report card. In addition, between 6% and 17% of consumers specifically identified using Nursing Home Compare when looking for a nursing home. The highest use of report cards was reported by family members of assisted-living residents, followed by family members of nursing home residents. Many consumers primarily used the report cards simply to find the location of nursing homes-a useful first step when examining the facility choices available. Yet relatively few consumers primarily used report cards for the arguably more important step of comparing quality information. Future research should investigate why the quality information is not used to a greater extent and what hinders consumers from using this information.
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Mukamel DB, Ladd H, Weimer DL, Spector WD, Zinn JS. Is there evidence of cream skimming among nursing homes following the publication of the Nursing Home Compare report card? THE GERONTOLOGIST 2009; 49:793-802. [PMID: 19491363 DOI: 10.1093/geront/gnp062] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE A national quality report card for nursing homes, Nursing Home Compare, has been published since 2002. It has been shown to have some, albeit limited, positive impact on quality of care. The objective of this study was to test empirically the hypothesis that nursing homes have responded to the publication of the report by adopting cream skimming admission policies. DESIGN AND METHODS The study included all non-Medicare newly admitted patients to all Medicare- and Medicaid-certified nursing homes nationally during the 2001-2005 period. Using the Minimum Data Set data, we calculated for each quarter several admission cohort characteristics: average number of activity of daily living limitations and percent of residents admitted with pain, with pressure ulcers, with urinary incontinence, with diabetes, and with memory limitations. We tested whether residents admitted in the postpublication period were less frail and sick compared with residents admitted in the prepublication period by estimating fixed facility effects longitudinal regression models. Analyses were stratified by nursing home ownership, occupancy, reported quality ranking, chain affiliation, and region. RESULTS Evidence for cream skimming was found with respect to pain and, to a lesser degree, with respect to memory limitation but not with respect to the 4 other admission cohort characteristics. IMPLICATIONS Despite the theoretical expectation, empirical evidence suggests only a limited degree of cream skimming. Further studies are required to investigate this phenomenon with respect to other admission cohort characteristics and with respect to post-acute patients.
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Affiliation(s)
- Dana B Mukamel
- Health Policy Research Institute, University of California, Irvine, Irvine, CA 92697-5800, USA.
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Abstract
PURPOSE We determine the rate of nursing home closures for 7 years (1999-2005) and examine internal (e.g., quality), organizational (e.g., chain membership), and external (e.g., competition) factors associated with these closures. DESIGN AND METHOD The names of the closed facilities and dates of closure from state regulators in all 50 states were obtained. This information was linked to the Online Survey, Certification, and Reporting data, which contains information on internal, organizational, and market factors for almost all nursing homes in the United States. RESULTS One thousand seven hundred and eighty-nine facilities closed over this time period (1999-2005). The average annual rate of closure was about 2 percent of facilities, but the rate of closure was found to be increasing. Nursing homes with higher rates of deficiency citations, hospital-based facilities, chain members, small bed size, and facilities located in markets with high levels of competition were more likely to close. High Medicaid occupancy rates were associated with a high likelihood of closure, especially for facilities with low Medicaid reimbursement rates. IMPLICATIONS As states actively debate about how to redistribute long-term care services/dollars, our findings show that they should be cognizant of the potential these decisions have for facilitating nursing home closures.
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Affiliation(s)
- Nicholas G Castle
- Graduate School of Public Health, University of Pittsburgh,Pittsburgh, PA 15261, USA.
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Abstract
The post-acute and long-term care systems are changing rapidly, with an increasingly important role being played by home care. Under the current system, home care does not consistently meet the needs of older people living in the community. This problem is caused, in large part, by the existing system of financing and regulating home care. This paper examines how the current system funded by Medicare, Medicaid, state programs, private insurance, and out-of-pocket spending affects the delivery and quality of home care services. Specifically, this paper analyzes how financing, coverage of services, reimbursement, quality regulation and assurance, and information coordination affects the quality of home care. The paper concludes by drawing implications for policy.
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Goodson J, Jang W. Assessing nursing home care quality through Bayesian networks. Health Care Manag Sci 2008; 11:382-92. [PMID: 18998597 DOI: 10.1007/s10729-008-9063-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This article demonstrates how Bayesian networks can be employed as a tool to assess the quality of care in nursing homes. For the data sets analyzed, the proposed model performs comparably to existing quantitative assessment models. In addition, a Bayesian network approach offers several unique advantages. The structure and parameters of a Bayesian network provide rich insight into the multidimensional aspects of the quality of care. Bayesian networks can be used as a guide in implementing limited resources by identifying information that would be most relevant to an assessment. Finally, Bayesian networks provide a straightforward framework for integrating nursing home care quality research that is conducted in various locations and for various purposes.
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Affiliation(s)
- Justin Goodson
- Department of Management Sciences, Henry B. Tippie College of Business, University of Iowa, Iowa City, IA 52242, USA
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Fisher LT, Wallhagen MI. Day-To-Day Care: The Interplay of CNAS’ Views of Residents & Nursing Home Environments. J Gerontol Nurs 2008; 34:26-33. [DOI: 10.3928/00989134-20081101-04] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Goodson J, Jang W, Rantz M. Nursing home care quality: insights from a Bayesian network approach. THE GERONTOLOGIST 2008; 48:338-48. [PMID: 18591359 DOI: 10.1093/geront/48.3.338] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The purpose of this research is twofold. The first purpose is to utilize a new methodology (Bayesian networks) for aggregating various quality indicators to measure the overall quality of care in nursing homes. The second is to provide new insight into the relationships that exist among various measures of quality and how such measures affect the overall quality of nursing home care as measured by the Observable Indicators of Nursing Home Care Quality Instrument. In contrast to many methods used for the same purpose, our method yields both qualitative and quantitative insight into nursing home care quality. DESIGN AND METHODS We construct several Bayesian networks to study the influences among factors associated with the quality of nursing home care; we compare and measure their accuracy against other predictive models. RESULTS We find the best Bayesian network to perform better than other commonly used methods. We also identify key factors, including number of certified nurse assistant hours, prevalence of bedfast residents, and prevalence of daily physical restraints, that significantly affect the quality of nursing home care. Furthermore, the results of our analysis identify their probabilistic relationships. IMPLICATIONS The findings of this research indicate that nursing home care quality is most accurately represented through a mix of structural, process, and outcome measures of quality. We also observe that the factors affecting the quality of nursing home care collectively determine the overall quality. Hence, focusing on only key factors without addressing other related factors may not substantially improve the quality of nursing home care.
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Affiliation(s)
- Justin Goodson
- Department Managment Sciences, University of Iowa, Iowa City, Iowa, USA
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Abstract
The author uses data from 8,023 nursing homes to examine state differences in turnover and vacancy rates and organizational characteristics associated with turnover rates. The analyses focus on nurse aides, licensed practical nurses, and registered nurses as caregivers. Findings show that the 2004 turnover and vacancy rates for these caregivers were high and that there were differences across states for turnover and vacancy rates. The author shows that staffing levels of caregivers, quality of care, and top management turnover are associated with caregiver turnover.
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Abstract
BACKGROUND The Centers for Medicare and Medicaid Services (CMS) publish a report card for nursing homes with 19 clinical quality measures (QMs). These measures include minimal risk adjustment. OBJECTIVES To develop QMs with more extensive risk adjustment and to investigate the impact on quality rankings. RESEARCH DESIGN Retrospective analysis of individual level data reported in the Minimum Data Set (MDS). Random effect logistic models were used to estimate risk adjustment models for 5 outcomes: pressure ulcers for high and low risk patients, physical restraints, and pain for long- and short-stay patients. These models were used to create 5 QMs with extended risk adjustment, enhanced QMs (EQMs). The EQMs were compared with the corresponding QMs. SUBJECTS All (17,469) nursing homes that reported MDS data in the period 2001-2005, and their 9.6 million residents. MEASURES QMs were compared with EQMs for all nursing homes in terms of agreement on outlier identification: Kappa, false positive and false negative error rates. RESULTS Kappa values ranged from 0.63 to 0.90. False positive and negative error rates ranged from 8% to 37%. Agreement between QMs and EQMs was better on high quality rather than on low quality. CONCLUSIONS More extensive risk adjustment changes quality ranking of nursing homes and should be considered as potential improvement to the current QMs. Other methodological issues related to construction of the QMs should also be investigated to determine if they are important in the context of nursing home care.
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Castle NG, Engberg J, Men A. Nursing home staff turnover: impact on nursing home compare quality measures. THE GERONTOLOGIST 2008; 47:650-61. [PMID: 17989407 DOI: 10.1093/geront/47.5.650] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We used data from a large sample of nursing homes to examine the association between staff turnover and quality. DESIGN AND METHODS The staff turnover measures came from primary data collected from 2,840 nursing homes in 2004 (representing a 71% response rate). Data collection included measures for nurse aides, licensed practical nurses, and registered nurses. We examined 14 indicators of care quality that came from the Nursing Home Compare Web site. RESULTS We found that reducing turnover from high to medium levels was associated with increased quality, but the evidence was mixed regarding the quality improvements from further lowering turnover to low levels. IMPLICATIONS Our investigation shows that the relationship between turnover and quality might not be linear. Nevertheless, in general, high turnover is associated with poor quality.
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Affiliation(s)
- Nicholas G Castle
- Graduate School of Public Health, University of Pittsburgh, A610 Crabtree Hall, 130 DeSoto Street, Pittsburgh, PA 15261, USA.
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Lestage C, Dubuc N, Bravo G. Identifying characteristics of residential care facilities relevant to the placement process of seniors. J Am Med Dir Assoc 2008; 9:95-101. [PMID: 18261701 DOI: 10.1016/j.jamda.2007.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Revised: 08/15/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To identify which characteristics of the physical and organizational environments of residential care facilities (RCFs) need to be known to support the placement process of seniors with cognitive and physical disabilities. DESIGN We used a 2-round postal Delphi survey based on the RAND/UCLA Appropriateness Method with 2 groups of experts. PARTICIPANTS Participants are representatives of concerned stakeholder groups from various sectors (public, private, and community) and geographical regions within the province of Quebec, Canada. RESULTS Of the 58 persons who were interested in participating, 48 (82.8%) returned their questionnaires. The first group identified 171 items essential to consider when a cognitively impaired senior needs to move into an RCF. Of these, 88 were related to the physical environment of the RCF and 83 to its organizational environment. The second group identified 146 items to be relevant to consider when a senior with physical impairments needs to choose an RCF; 75 for the physical and 71 for the organizational environment. 85% of the items selected by both groups (cognitive versus physical group) were identical. CONCLUSION This study provided a list of important items that described residential care facilities in regard to their physical and organizational environments to support the placement process of seniors. It also provides the possibility to develop a self-administered tool that will supply valuable information to seniors and their relatives, to health care professionals, and to administrators and decisions-makers.
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Affiliation(s)
- Catherine Lestage
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Quebec, Canada.
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Abstract
OBJECTIVE The influence staffing levels, turnover, worker stability, and agency staff had on quality of care in nursing homes was examined. DATA SOURCES/STUDY SETTING Staffing characteristics came from a survey of nursing homes (N=1,071) conducted in 2003. The staffing characteristics were collected for Nurse Aides, Licensed Practical Nurses, and Registered Nurses. Fourteen quality indicators came from the Nursing Home Compare website report card and nursing home organizational characteristics came from the Online Survey, Certification, and Recording system. STUDY DESIGN One index of quality (the outcome) was created by combining the 14 quality indicators using exploratory factor analysis. We used regression analyses to assess the effect of the four staffing characteristics for each of the three types of nursing staff on this quality index in addition to individual analyses for each of the 14 quality indicators. The effect of organizational characteristics as well as the markets in which they operated on outcomes was examined. We examined a number of different model specifications. PRINCIPAL FINDINGS Quality of care was influenced, to some degree, by all of these staffing characteristics. However, the estimated interaction effects indicated that achieving higher quality was dependent on having more than one favorable staffing characteristic--the effect of quality was larger than the sum of the independent effects of each favorable staffing characteristic. CONCLUSIONS Our results indicate that staff characteristics such as turnover, staffing levels, worker stability, and agency staff should be addressed simultaneously to improve the quality of nursing homes.
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Affiliation(s)
- Nicholas G Castle
- Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, PA 15261, USA
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Abstract
BACKGROUND Although both quality and cost are important concerns for long term care (LTC) facility management and policy, the relationship between cost and quality is poorly understood. Such knowledge is necessary to guide facility management and policy action. OBJECTIVE We sought to determine the net effect of quality on cost in LTC hospital settings. STUDY SAMPLE A 4-year panel dataset from April 1997 through March 2002 comprising observations from 99 LTC hospitals were included in this analysis. METHODS We examined the relationship between direct resident costs and 7 indicators of quality for long-stay residents. We used panel data methods to control for unobserved facility-level characteristics. RESULTS We found that increases in restraint use and incident pressure/skin ulcers were associated with lower per diem costs, whereas incontinence prevalence was associated with higher per diem costs. CONCLUSIONS Our results point to different implications regarding cost and quality for different quality indicators. Although facilities have a strong internal business case to improve quality in incontinence, policy-makers may need to provide financial incentives to encourage reductions in restraint use and incident skin ulcers so as to defray potential higher costs associated with improving quality in these areas.
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Affiliation(s)
- Walter P Wodchis
- Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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Abstract
BACKGROUND Recent work on nursing home staffing and turnover has stressed the importance of ownership and resources. However, few studies have examined spending behaviors, which might also influence staffing levels and staff turnover rates. PURPOSE This study investigates whether spending behaviors measured by financial ratios are associated with staffing levels and staff turnover in nursing homes. METHODOLOGY We analyzed cross-sectional data from 1,014 Texas homes. Data were from the 2002 Texas Nursing Facility Medicaid Cost Report and the 2003 Area Resource File. First, we examined differences in financial ratios by ownership type. Next, the effect of 10 financial ratios on staffing levels and turnover rates for registered nurses, licensed vocational nurses, and certified nursing assistants was examined using robust regression models. FINDINGS Descriptive data indicated that expense ratios related to resident care activities and staff development were significantly higher among not-for-profit than for-profit homes. Higher profits were associated with lower staffing levels, but not higher turnover rates. Administrative expenses (a measure of management capacity) had a negative impact both on staffing levels and staff turnover for licensed vocational nurses and certified nursing assistants, but they did not affect registered nurse staffing. Employee benefit expenses exhibited a positive impact on registered nurse and licensed vocational nurse staffing levels. The addition of information on financial ratios to models predicting staffing indicators reduced the effect of ownership on these indicators. PRACTICE IMPLICATIONS Solutions to the staffing and turnover problem should focus on more effective management practices. Certain levels of administrative and staff benefit expenses may be necessary to improve professional staff recruitment and reduce both staffing and turnover costs. Differences in these financial ratios may partially explain the role played by ownership in determining staffing levels and turnover.
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Affiliation(s)
- Bita A Kash
- Department of Health Policy and Management, School of Rural Public Health, Texas A&M University Health Science Center, College Station, TX, USA.
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Castle NG, Engberg J, Liu D. Have Nursing Home Compare quality measure scores changed over time in response to competition? Qual Saf Health Care 2007; 16:185-91. [PMID: 17545344 PMCID: PMC2465007 DOI: 10.1136/qshc.2005.016923] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Currently, the Centers for Medicare and Medicaid Services report on 15 Quality Measures (QMs) on the Nursing Home Compare (NHC) website. It is assumed that nursing homes are able to make improvements on these QMs, and in doing so they will attract more residents. In this investigation, we examine changes in QM scores, and whether competition and/or excess demand have influenced these change scores over a period of 1 year. METHODS Data come from NHC and the On-line Survey Certification And Recording (OSCAR) system. QM change scores are calculated using values from January 2003 to January 2004. A series of regression analyses are used to examine the association of competition and excess demand on QM scores. RESULTS Eight QMs show an average decrease in scores (ie, better quality) and six QMs show an average increase in scores (ie, worse quality). However, for 13 of the 14 QMs these average changes averaged less than 1%. The regression analyses show an association between higher competition and improving QM scores and an association between lower occupancy and improving QM scores. CONCLUSION As would be predicted based on the market-driven mechanism underlying quality improvements using report cards, we show that it is in the most competitive markets and those with the lowest average occupancy rates that improvements in the QM scores are more likely.
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Adams-Wendling L, DeDonder J, Tidwell S, Pimple C, Schmiot L, Okeson D. Budgeting nursing workload for required minimum data set assessments. J Nurs Manag 2007; 15:442-8. [PMID: 17456173 DOI: 10.1111/j.1365-2834.2007.00685.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM The purpose of this study was to evaluate the reliability and validity of an instrument used to measure nursing workload of federally mandated assessments. Specifically, the instrument measures the nursing workload of the resident assessment instrument the mandated assessment tool used in nursing facilities. BACKGROUND It is imperative that nursing managers and nurse executives in health care organizations have a process to budget Registered Nurse full-time equivalents required for federally mandated assessments. METHODS The sample (N=48) included nursing facility minimum data set Coordinators. Reliability and validity scores of the nursing workload instrument are calculated using Pearson correlation coefficients (r). RESULTS The nursing workload instrument demonstrated reliability and validity. Total nursing workload to complete the minimum data set for nursing facilities is summarized. CONCLUSION The results provide support for a reliable and valid instrument to measure nursing workload for standardized minimum data set assessments.
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Lee RH, Gajewski BJ, Thompson S. Reliability of the Nursing Home Survey Process: A Simultaneous Survey Approach. THE GERONTOLOGIST 2006; 46:772-9. [PMID: 17169932 DOI: 10.1093/geront/46.6.772] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE We designed this study to examine the reliability of the nursing home survey process in the state of Kansas using regular and simultaneous survey teams. In particular, the study examined how two survey teams exposed to the same information at the same time differed in their interpretations. DESIGN AND METHODS The protocol for simultaneous surveys consists of having one in-region and one out-of-region team survey a facility together. RESULTS The regular and simultaneous survey teams generally agreed about the number of deficiencies. The intraclass correlation coefficient was 0.87 for total deficiencies and 0.76 for deficiencies with scores of G or higher. But in a substantial number of instances the teams did not agree about the scope and severity of the deficiency or about what regulation the nursing home had breached. IMPLICATIONS The survey process is reliable when assessing aggregate results, but it is only moderately reliable when examining individual citations. Stakeholders (i.e., consumers, policy makers, nursing home administrators) should be aware of the limitations of the survey process. It needs to be modified to reduce variability.
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Affiliation(s)
- Robert H Lee
- Department of Health Policy and Management, University of Kansas Medical Center, Mail Stop 3044, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
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Gajewski BJ, Thompson S, Dunton N, Becker A, Wrona M. Inter-rater reliability of nursing home surveys: a Bayesian latent class approach. Stat Med 2006; 25:325-44. [PMID: 15977287 DOI: 10.1002/sim.2224] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the U.S., federal and state governments perform routine inspections of nursing homes. Results of the inspections allow government to generate fines for findings of non-compliance as well as allow consumers to rank facilities. The purpose of this study is to investigate the inter-rater reliability of the nursing home survey process. In general, the survey data involves 191 binary deficiency variables interpreted as 'deficient' or 'non-deficient'. To reduce the dimensionality of the problem, our proposed method involves two steps. First, we reduce the deficiency categories to sub-categories using previous nursing home studies. Second, looking at the State of Kansas specifically, we take the deficiency data from 1 year, and use Bayesian latent class analysis (LCA) to collapse the sub-categories to a binary variable. We evaluate inter-rater agreement using deficiency data from two separate survey teams on one facility, a matched-pair design. We evaluate the agreement of the two raters on binary data using the weights from the LCA. This allows a two-by-two contingency analysis using a Bayesian beta-binomial model. We elicit informative prior distributions from the nursing home providers. Together, with the experimental data, this provides a posterior distribution of the kappa agreement of the raters for nursing home deficiency citation data.
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Affiliation(s)
- Byron J Gajewski
- Schools of Allied Health and Nursing, University of Kansas, Kansas City, KS 66160, USA.
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Abstract
Publicly reporting information stimulates providers' efforts to improve the quality of health care. The availability of mandated, uniform clinical data in all nursing homes and home health agencies has facilitated the public reporting of comparative quality data. This article reviews the conceptual and technical challenges of applying information about the quality of long-term care providers and the evidence for the impact of information-based quality improvement. Quality "tools" have been used despite questions about the validity of the measures and their use in selecting providers or offering them bonus payments. Although the industry now realizes the importance of quality, research still is needed on how consumers use this information to select providers and monitor their performance and whether these efforts actually improve the outcomes of care.
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Affiliation(s)
- Vincent Mor
- Department of Community Health and Center for Gerontology and Health Care Research, Brown University School of Medicine, Box G-A418, Providence, RI 02192, USA.
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Abstract
This paper reports on an exploratory study of nursing home bankruptcy. From state and industry data regarding nearly 1,000 California facilities, it was possible to identify 155 homes in five chains (multi-facility organizations) that were operating in bankruptcy in 2000. When compared with facilities in non-bankrupt chains, while the bankrupt chain facilities had significantly worse financial liquidity, higher administrative costs, and higher payables to related parties, they also had more Medicare residents, fewer Medicaid residents, better solvency, and were located in less competitive county markets and in areas with higher Medicaid reimbursement rates. These findings indicate that, rather than facility characteristics and local market factors, strategic decisions taken at the corporate (chain) level are the major determinants of nursing facility bankruptcy status.
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Affiliation(s)
- Martin Kitchener
- Department of Social and Behavioral Sciences, University of California, San Francisco 94118, USA.
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Alvine C. Improving Quality of Care Through Systems Research: A Guide for Managers and Practitioners. Geriatr Nurs 2005; 26:294-9. [PMID: 16276652 DOI: 10.1016/j.gerinurse.2005.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ceanne Alvine
- John A. Hartford Scholar University of Arizona, College of Nursing, Tucson, AZ, USA
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Abstract
PURPOSE In this work, the association between nurse aide (NA) plus licensed practical nurse (LPN) and registered nurse (RN) turnover and quality indicators in nursing homes is examined. DESIGN AND METHODS Indicators of care quality used are the rates of physical restraint use, catheter use, contractures, pressure ulcers, psychoactive drug use, and certification survey quality of care deficiencies. In addition, we used a quality index combining these indicators. Turnover information came from primary data collected from 354 facilities in 4 states and other information came from the 2003 Online Survey, Certification and Reporting data. The turnover rates were grouped into 3 categories, low, medium, and high, defined as 0% to 20%, 21% to 50%, and greater than 50% turnover, respectively. RESULTS The average 1-year turnover rates identified in this study were high at 85.8% for NAs and LPNs and 55.4% for RNs. Multivariate analysis shows that decreases in quality are associated with increases in RN turnover, especially increases from low-to-moderate levels of turnover, and with increases in NA and LPN turnover, especially increases from moderate-to-high levels of turnover. IMPLICATIONS These findings are significant because the belief that staff turnover influences quality is pervasive. The cross-sectional results are only able to show associations, nonetheless, few empirical studies in the literature have shown this relationship.
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Affiliation(s)
- Nicholas G Castle
- Graduate School of Public Health, University of Pittsburgh, Pennsylvania 15261, USA.
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Abstract
BACKGROUND Effective discharge planning and well-coordinated case management related to nursing home (NH) placement are key services in acute-care hospitals. OBJECTIVES (1) identify the individuals and important factors involved in the discharge planning process; (2) describe the types/sources of information used by discharge planners to recommend specific nursing homes for patients and families; and (3) determine which methods are used to evaluate the quality of US nursing homes (NHs). METHODS Descriptive study, with a convenience sample of 41 discharge planners and case managers from California acute-care hospitals. RESULTS This study found that patients, families, friends, and physicians are all involved in the discharge planning process along with discharge planners and/or case managers. Discharge planners/case managers were generally concerned about NH bed availability, geographic location, and financial considerations. Although the discharge planners and case managers were able to articulate important indicators of quality in NHs, such information was not routinely considered during discharge planning activities. CONCLUSIONS Discharge planners and case managers need to play a more central role in the decision-making process related to the selection of a NH, especially because decisions are time-limited and can benefit from a well-planned discharge planning program that uses a variety of data on quality and costs. The widespread use of Internet-based information sources can be expanded to aid this process.
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Affiliation(s)
- Eric J Collier
- Department of Social and Behavorial Sciences, School of Nursing, University of California, San Francisco 94118, USA.
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O'Meara J, Kitchener M, Collier E, Lyons M, de Billwiller-Kiss A, Simon LP, Harrington C. Case study: development of and stakeholder responses to a nursing home consumer information system. Am J Med Qual 2005; 20:40-50. [PMID: 15782754 DOI: 10.1177/1062860604273773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
California Nursing Home Search (www.calnhs.org), launched in October 2002, provides information about nursing home quality to a broad range of stakeholders. This case study discusses the process of developing a consumer-oriented nursing home Web site and presents an analysis of postlaunch responses from a number of sources (i.e., media, outreach, Web site use, correspondence, meetings, interviews) to determine the impact of the site and how it can be improved and used as an example. Consumers found the Web site valuable, but some needed clarification on navigation. Providers had complaints about the use of quality ratings and concerns about public availability of the data. Most discharge planners and care managers do not use Internet resources to find facilities. Feedback, modifications, updates, and outreach are needed on a continuous basis to ensure the site is a helpful tool for all stakeholders.
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Affiliation(s)
- Janis O'Meara
- Department of Social and Behavioral Sciences, University of California, San Francisco 94118, USA.
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Arling G, Kane RL, Lewis T, Mueller C. Future Development of Nursing Home Quality Indicators. THE GERONTOLOGIST 2005; 45:147-56. [PMID: 15799979 DOI: 10.1093/geront/45.2.147] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Nursing home quality indicators have been developed over the past 10 years to quantify nursing home quality and to draw systematic comparisons between facilities. Although these indicators have been applied widely for nursing home regulation, quality improvement, and public reporting, researchers and stakeholders have raised concerns about their accuracy and usefulness. We critically evaluate nursing home quality indicators from the standpoint of theory, measurement, and application, and we recommend strategies to make the indicators more valuable as quality assessment tools. We recommend that (a) more comprehensive quality indicators should be developed in conjunction with the new Minimum Data Set 3.0; (b) the validity and reliability of the indicators should be evaluated thoroughly with respect to both measurement and application; (c) statistical criteria should be incorporated explicitly into quality indicator scoring and outlier targeting; (d) the dimensionality and theoretical structure of the quality indicators should be carefully examined; (e) risk adjustment methods should be refined and broadened; and (f) quality indicator reporting systems should be strengthened and tailored to stakeholders' needs.
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Affiliation(s)
- Greg Arling
- Cookingham Institute, University of Missouri at Kansas City, Kansas City, MO 64110, USA.
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45
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Abstract
PURPOSE We first describe which states have produced nursing home report cards; second, we compare what information is provided in these report cards; third, we identify data sources used to produce the report cards; and, finally, we examine seven factors previously shown to be associated with the usefulness of report-card information and provide several examples from current reporting efforts to illustrate how nursing home report cards could be improved. DESIGN AND METHODS We searched the Web sites for each state agency responsible for elder affairs-nursing homes. For those states identified as having a nursing home report card, we further examined the information presented. RESULTS We identified 19 states as having nursing home report cards (AZ, CO, FL, IL, IN, IO, MD, MA, MS, NV, NJ, NY, OH, PA, RI, TX, UT, VT, and WI). The information presented in these report cards differs quite substantially across states, although the data sources for report cards do not differ substantially. How the information is presented and our evaluation of the usefulness of the information is also highly varied. IMPLICATIONS Providing nursing home report-card information may be important in helping elders and their families choose a nursing facility. With 19 states identified in our research as providing nursing home report-card information on the World Wide Web, we were surprised and encouraged at this number of initiatives. We give some insight into the kinds of information that can be found on these report cards and what steps could be taken to improve how the information is presented.
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Affiliation(s)
- Nicholas G Castle
- University of Pittsburgh, Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, PA 15261, USA.
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46
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Abstract
BACKGROUND State survey agencies collect and investigate consumer complaints for care in nursing homes and other health care settings. Complaint investigations play a key role in quality assurance, because they can respond to concerns of consumers and families. OBJECTIVE This study uses 5 years of nursing home complaints data from Massachusetts (1998-2002) to investigate whether complaints might be used to assess nursing home quality of care. RESEARCH DESIGN The investigator matches facility-level complaints data with On-Line Survey Certification and Reporting (OSCAR) data and Minimum Data Set Quality Indicator (MDS QI) data to evaluate the association between consumer complaints, facility and resident characteristics, and other nursing home quality measures. RESULTS Consumer complaints varied across facility characteristics in ways consistent with the nursing home quality literature. Complaints were consistently and significantly associated with survey deficiencies, the presence of a serious survey deficiency, and nurse aide staffing. Complaints were not significantly associated with nurse staffing, and associations with 6 MDS QIs were mixed. The number of complaints was significantly predictive of survey deficiencies identified at the subsequent inspection. CONCLUSION Nursing home consumer complaints provide a supplemental tool with which to differentiate nursing homes on quality. Despite limitations, complaints data have potential strengths when used in combination with other quality measures. The potential of using consumer complaints to assess nursing home quality of care should be evaluated in states beyond Massachusetts. Evaluating consumer complaints also might be a productive area of inquiry for other health care settings such as hospitals and home health agencies.
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Affiliation(s)
- David G Stevenson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Morgan LA, Eckert JK, Gruber-Baldini AL, Zimmerman S. Policy and Research Issues for Small Assisted Living Facilities. J Aging Soc Policy 2004; 16:1-16. [PMID: 15724570 DOI: 10.1300/j031v16n04_01] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dramatic growth in Assisted Living (AL) has resulted in increasing research and policy interest. This analysis compares smaller and larger AL facilities in four states to determine whether extant measures of four key concepts, used to distinguish the AL sector, give advantage to larger facilities. Quantitative comparisons predominantly show differences favorable to larger facilities; qualitative information raises the prospect that current measures overlook beneficial aspects of smaller facilities. If small facilities are included under the AL banner. both policy provisions and quality assessment must be carefully crafted to avoid placing small homes in funding and oversight jeopardy as AL develops.
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Affiliation(s)
- Leslie A Morgan
- Department of Sociology and Anthropology, University of Maryland. Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA.
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Abstract
This article is an examination of websites providing consumer information about nursing home quality of care, including existing federal and state websites and a new comprehensive website designed for California nursing homes. The article focuses on research and information related to nursing indicators of quality used for the California nursing home website. It includes staffing levels (e.g., hours, types, turnover rates), financial indicators (e.g., direct care expenditures, wages, benefits), and complaints and deficiencies. Overall, nursing indicators of quality are a major approach for evaluating nursing home quality and can be used by nurses, consumers, and advocates.
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Affiliation(s)
- Charlene Harrington
- Department of Social and Behavioral Sciences, University of California, San Francisco, 3333 California Street, Suite 455, San Francisco, CA 94118, USA
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