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| Explore the relationships between the processes of care in place in facilities and their care quality, resident outcomes, costs, and staffing (NINR-funded) |
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Purpose: The purpose of this study was to describe the processes of care, organizational attributes, cost of care, staffing level, and staff mix in a sample of Missouri homes with good, average, and poor resident outcomes.
Design and Methods: A three-group exploratory study design was used, with 92 nursing homes randomly selected from all nursing homes in Missouri and classified into resident outcome groups. Resident outcomes were measured using quality indicators (QIs) derived from nursing home Minimum Data Set (MDS) resident assessment data. Cost and staffing information were derived from Medicaid Cost Reports. Participant observation methods were used to describe the care delivery processes. Results: In facilities with good resident outcomes, there are basics of care and processes surrounding each that staff consistently do: helping residents with ambulation, nutrition and hydration, toileting and bowel regularity, preventing skin breakdown, and managing pain. The analysis revealed necessary organizational attributes that must be in place in order for those basics of care to be accomplished: Consistent nursing and administrative leadership, the use of team and group processes, and an active quality improvement program. The only facility characteristic across the outcome groups that was significantly different was number of licensed beds with smaller facilities having better outcomes. No significant differences in costs, staffing, or staff mix were detected across the groups. A trend in higher total costs of $13.58 per resident per day was detected in the poor outcome group compared to the good outcome group. Implications: For nursing homes to achieve good resident outcomes, they must have leadership that is willing to embrace quality improvement, group process, and see that the basics of care delivery are done for residents. Good quality care appears to cost less than poor quality care. Smaller facilities of 60 beds were more likely to have good resident outcomes. Strategies need to be considered so larger facilities can be organized into smaller clusters of units that could function as small nursing homes within the larger whole. Rantz, M.J., Grando, V., Conn, V.S., Zwygart-Stauffacher, M., Hicks, L., Flesner, M., Scott, J., Manion, P., Minner, D., Porter, R., and Mass, M. (2003). Getting the basics right: Care delivery in nursing homes. Journal of Gerontological Nursing, 29(11): 15-25. Rantz, M., Hicks, L., Petroski, G.F., Madsen, R.W., Conn, V., Zwygart-Stauffacher, M., & Maas, M. (2003). High-quality nursing home care is more cost effective than low-quality care. Long-Term Care Interface, 4(9): 18-20. Rantz, M.J., Hicks, L., Grando, V.T., Petroski, G.F., Madsen, R.W., Mehr, D.R., Conn, V., Zwygart-Stauffacher, M., Scott, J., Flesner, M., Bostick, J., Porter, R., & Maas, M. (2004) Nursing Home Quality, Cost, Staffing, and Staff-Mix. The Gerontologist, 44(1): 24-38. Rantz, M.J., Hicks, L., Petroski, G.F., Madsen, R.W., Mehr, D.R., Conn, V., Zwygart-Stauffacher, M., & Maas, M. (2004). Stability and sensitivity of nursing home quality indicators. Journal of Gerontology: Medical Science, 59A(1): 79-82. |