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1.
Nurs Outlook ; 71(1): 101897, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36621418

RESUMO

For a number of decades, nurses have raised concerns about nursing-related issues in nursing homes (NH) such as inadequate registered nurse (RN) staffing, insufficient RN and advanced practice registered nurse (APRN) gerontological expertise, and lack of RN leadership competencies. The NASEM Committee on the Quality of Care in Nursing Homes illuminated the long-standing issues and concerns affecting the quality of care in nursing homes and proposed seven goals and associated recommendations intended to achieve the Committee's vision: Nursing home residents receive care in a safe environment that honors their values and preferences, addresses goals of care, promotes equity, and assesses the benefits and risks of care and treatments. This paper outlines concrete and specific actions nurses and nursing organizations can take to ensure the recommendations are implemented.


Assuntos
Geriatria , Enfermeiras e Enfermeiros , Humanos , Casas de Saúde , Recursos Humanos , Qualidade da Assistência à Saúde
2.
J Am Med Dir Assoc ; 19(6): 541-550, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29208447

RESUMO

PURPOSE: The purpose of this article is to review the impact of advanced practice registered nurses (APRNs) on the quality measure (QM) scores of the 16 participating nursing homes of the Missouri Quality Initiative (MOQI) intervention. The MOQI was one of 7 program sites in the US, with specific interventions unique to each site tested for the Centers for Medicaid and Medicare Services Innovations Center. While the goals of the MOQI for long-stay nursing home residents did not specifically include improvement of the QM scores, it was anticipated that improvement most likely would occur. Primary goals of the MOQI were to reduce the frequency of avoidable hospital admissions and readmissions; improve resident health outcomes; improve the process of transitioning between inpatient hospitals and nursing facilities; and reduce overall healthcare spending without restricting access to care or choice of providers. METHODS: A 2-group comparison analysis was conducted using statewide QMs; a matched comparison group was selected from facilities in the same counties as the intervention homes, similar baseline QM scores, similar size and ownership. MOQI nursing homes each had an APRN embedded full-time to improve care and help the facility achieve MOQI goals. Part of their clinical work with residents and staff was to focus on quality improvement strategies with potential to influence healthcare outcomes. Trajectories of QM scores for the MOQI intervention nursing homes and matched comparison group homes were tested with nonparametric tests to examine for change in the desired direction between the 2 groups from baseline to 36 months. A composite QM score for each facility was constructed, and baseline to 36-month average change scores were examined using nonparametric tests. Then, adjusting for baseline, a repeated measures analysis using analysis of covariance as conducted. RESULTS: Composite QM scores of the APRN intervention group were significantly better (P = .025) than the comparison group. The repeated measures analysis identified statistically significant group by time interaction (P = .012). Then group comparisons were made at each of the 6-month intervals and statistically significant differences were found at 24 months (P = .042) and 36 months (P = .002), and nearly significant at 30 months (P = .11). IMPLICATIONS: APRNs working full time in nursing homes can positively influence quality of care, and their impact can be measured on improving QMs. As more emphasis is placed on quality and outcomes for nursing home services, providers need to find successful strategies to improve their QMs. Results of these analyses reveal the positive impact on QM outcomes for the majority of the MOQI nursing homes, indicating budgeting for APRN services can be a successful strategy.


Assuntos
Prática Avançada de Enfermagem , Papel do Profissional de Enfermagem , Casas de Saúde/normas , Garantia da Qualidade dos Cuidados de Saúde , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Medicare , Missouri , Objetivos Organizacionais , Estados Unidos
3.
Nurs Outlook ; 65(6): 689-696, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28993075

RESUMO

BACKGROUND: Centers for Medicare and Medicaid Innovation Center sponsored the initiative to reduce avoidable hospitalizations among nursing facility residents. PURPOSE: Missouri Quality Initiative (MOQI) designed inter-professional model in nursing homes with advanced practice registered nurses (APRNs). METHOD: MOQI APRN model was implemented for 4 years in 16 nursing homes in a metro area of the Midwest. Hospitalizations were reduced (40% all-cause, 58% potentially avoidable), emergency room visits (54% all-cause, 65% potentially avoidable), Medicare expenditures for hospitalizations (34% all-cause, 45% potentially avoidable), and Medicare expenditures for emergency room visits (50% all-cause, 60% potentially avoidable) for long-stay nursing home residents. DISCUSSION: Success of the MOQI model reinforces decades of research demonstrating that care provided by APRNs is cost-effective, safe, and associated with positive health outcomes and patient satisfaction. CONCLUSION: Nursing homes can implement and benefit by hiring APRNs. However, changes in the Code of Federal Regulation (CFR 483.40) are necessary to improve patient access to care and encourage hiring APRNs in US nursing homes.


Assuntos
Prática Avançada de Enfermagem , Custos de Cuidados de Saúde , Casas de Saúde , Qualidade da Assistência à Saúde , Hospitalização , Humanos , Missouri , Modelos de Enfermagem , Papel do Profissional de Enfermagem , Estados Unidos
4.
J Am Med Dir Assoc ; 18(11): 960-966, 2017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-28757334

RESUMO

PURPOSE: The goals of the Missouri Quality Initiative (MOQI) for long-stay nursing home residents were to reduce the frequency of avoidable hospital admissions and readmissions, improve resident health outcomes, improve the process of transitioning between inpatient hospitals and nursing facilities, and reduce overall healthcare spending without restricting access to care or choice of providers. The MOQI was one of 7 program sites in the United States, with specific interventions unique to each site tested for the Centers for Medicaid and Medicare Services (CMS) Innovations Center. DESIGN AND METHODS: A prospective, single group intervention design, the MOQI included an advanced practice registered nurse (APRN) embedded full-time within each nursing home (NH) to influence resident care outcomes. Data were collected continuously for more than 3 years from an average of 1750 long-stay Medicare, Medicaid, and private pay residents living each day in 16 participating nursing homes in urban, metro, and rural communities within 80 miles of a major Midwestern city in Missouri. Performance feedback reports were provided to each facility summarizing their all-cause hospitalizations and potentially avoidable hospitalizations as well as a support team of social work, health information technology, and INTERACT/Quality Improvement Coaches. RESULTS: The MOQI achieved a 30% reduction in all-cause hospitalizations and statistically significant reductions in 4 single quarters of the 2.75 years of full implementation of the intervention for long-stay nursing home residents. IMPLICATIONS: As the population of older people explodes in upcoming decades, it is critical to find good solutions to deal with increasing costs of health care. APRNs, working with multidisciplinary support teams, are a good solution to improving care and reducing costs if all nursing home residents have access to APRNs nationwide.


Assuntos
Redução de Custos , Instituição de Longa Permanência para Idosos/organização & administração , Hospitalização/estatística & dados numéricos , Casas de Saúde/organização & administração , Melhoria de Qualidade , Idoso , Idoso de 80 Anos ou mais , Centers for Medicare and Medicaid Services, U.S. , Estudos de Coortes , Feminino , Avaliação Geriátrica/métodos , Hospitalização/economia , Humanos , Incidência , Assistência de Longa Duração/organização & administração , Masculino , Missouri , Estudos Prospectivos , Estados Unidos
5.
Health Soc Work ; 41(4): 228-234, 2016 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-29206978

RESUMO

As part of an intervention to improve health care in nursing homes with the goal of reducing potentially avoidable hospital admissions, 1,877 resident records were reviewed for advance directive (AD) documentation. At the initial phases of the intervention, 50 percent of the records contained an AD. Of the ADs in the resident records, 55 percent designated a durable power of attorney for health care, most often a child (62 percent), other relative (14 percent), or spouse (13 percent). Financial power of attorney documents were sometimes found within the AD, even though these documents focused on financial decision making rather than health care decision making. Code status was the most prevalent health preference documented in the record at 97 percent of the records reviewed. The intervention used these initial findings and the philosophical framework of respect for autonomy to develop education programs and services on advance care planning. The role of the social worker within an interdisciplinary team is discussed.


Assuntos
Diretivas Antecipadas , Documentação , Casas de Saúde , Cuidados Paliativos , Diretivas Antecipadas/ética , Tomada de Decisões , Documentação/ética , Documentação/normas , Feminino , Humanos , Masculino , Medicaid , Medicare , Missouri , Casas de Saúde/ética , Casas de Saúde/normas , Cuidados Paliativos/ética , Cuidados Paliativos/normas , Melhoria de Qualidade , Estados Unidos
7.
Nurs Econ ; 33(6): 306-13, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26845818

RESUMO

The goal of this study was to compare utilization and cost outcomes of patients who received long-term care coordination in an Aging in Place program to patients who received care coordination as a routine service in home health care. This research offered the unique opportunity to compare two groups of patients who received services from a single home health care agency, using the same electronic health record, to identify the impact of long-term and routine care coordination on utilization and costs to Medicare and Medicaid programs. This study supports that long-term care coordination supplied by nurses outside of a primary medical home can positively influence functional, cognitive, and health care utilization for frail older people. The care coordinators in this study practiced nursing by routinely assessing and educating patients and families, assuring adequate service delivery, and communicating with the multidisciplinary health care team. Care coordination managed by registered nurses can influence utilization and cost outcomes, and impact health and functional abilities.


Assuntos
Envelhecimento , Continuidade da Assistência ao Paciente , Custos de Cuidados de Saúde , Serviços de Assistência Domiciliar/organização & administração , Idoso , Serviços de Assistência Domiciliar/economia , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Missouri
8.
J Gerontol Nurs ; 39(7): 18-22, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23675644

RESUMO

Falls are a major problem in older adults. A continuous, unobtrusive, environmentally mounted (i.e., embedded into the environment and not worn by the individual), in-home monitoring system that automatically detects when falls have occurred or when the risk of falling is increasing could alert health care providers and family members to intervene to improve physical function or manage illnesses that may precipitate falls. Researchers at the University of Missouri Center for Eldercare and Rehabilitation Technology are testing such sensor systems for fall risk assessment (FRA) and detection in older adults' apartments in a senior living community. Initial results comparing ground truth (validated measures) of FRA data and GAITRite System parameters with data captured from Microsoft(®) Kinect and pulse-Doppler radar are reported.


Assuntos
Acidentes por Quedas , Medição de Risco , Medidas de Segurança , Idoso , Humanos , Segurança
9.
J Am Med Dir Assoc ; 13(1): 60-8, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21816681

RESUMO

OBJECTIVES: A comprehensive multilevel intervention was tested to build organizational capacity to create and sustain improvement in quality of care and subsequently improve resident outcomes in nursing homes in need of improvement. DESIGN/SETTING/PARTICIPANTS: Intervention facilities (N = 29) received a 2-year multilevel intervention with monthly on-site consultation from expert nurses with graduate education in gerontological nursing. Attention control facilities (N = 29) that also needed to improve resident outcomes received monthly information about aging and physical assessment of elders. INTERVENTION: The authors conducted a randomized clinical trial of nursing homes in need of improving resident outcomes of bladder and bowel incontinence, weight loss, pressure ulcers, and decline in activities of daily living. It was hypothesized that following the intervention, experimental facilities would have higher quality of care, better resident outcomes, more organizational attributes of improved working conditions than control facilities, higher staff retention, similar staffing and staff mix, and lower total and direct care costs. RESULTS: The intervention did improve quality of care (P = .02); there were improvements in pressure ulcers (P = .05) and weight loss (P = .05). Organizational working conditions, staff retention, staffing, and staff mix and most costs were not affected by the intervention. Leadership turnover was surprisingly excessive in both intervention and control groups. CONCLUSION AND IMPLICATIONS: Some facilities that are in need of improving quality of care and resident outcomes are able to build the organizational capacity to improve while not increasing staffing or costs of care. Improvement requires continuous supportive consultation and leadership willing to involve staff and work together to build the systematic improvements in care delivery needed. Medical directors in collaborative practice with advanced practice nurses are ideally positioned to implement this low-cost, effective intervention nationwide.


Assuntos
Casas de Saúde/normas , Avaliação de Resultados em Cuidados de Saúde , Melhoria de Qualidade/organização & administração , Custos e Análise de Custo , Pessoal de Saúde/organização & administração , Pessoal de Saúde/psicologia , Humanos , Missouri
10.
Nurs Outlook ; 59(1): 37-46, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21256361

RESUMO

A state-sponsored evaluation of aging in place (AIP) as an alternative to assisted living and nursing home has been underway in Missouri. Cost, physical, and mental health assessment data reveal the cost-effectiveness and positive health measures of AIP. Findings of the first four years of the AIP evaluation of two long-term care settings in Missouri with registered nurse care coordination are compared with national data for traditional long-term care. The combined care and housing cost for any resident who received care services beyond base services of AIP and who qualified for nursing home care has never approached or exceeded the cost of nursing home care at either location. Both mental health and physical health measures indicate the health restoration and independence effectiveness of the AIP model for long-term care.


Assuntos
Serviços de Assistência Domiciliar/organização & administração , Instituição de Longa Permanência para Idosos/organização & administração , Vida Independente , Casas de Saúde/organização & administração , Idoso , Idoso de 80 Anos ou mais , Comportamento do Consumidor , Feminino , Pesquisa sobre Serviços de Saúde , Nível de Saúde , Serviços de Assistência Domiciliar/economia , Instituição de Longa Permanência para Idosos/economia , Humanos , Tempo de Internação , Masculino , Modelos de Enfermagem , Casas de Saúde/economia
11.
Comput Inform Nurs ; 28(6): 325-32, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20978402

RESUMO

Technology offers potential solutions to the pending crisis of healthcare for older adults, while healthcare workers are in short supply. Technology can enable remote monitoring of individuals and early detection of potential problems, so that early interventions can help older adults remain as healthy and independent as possible. Research is under way with passive monitoring technology in senior housing that is finding patterns in the data that can enhance nurse care coordination through early illness detection. With early detection, interventions can be more effective and reduce hospitalization and other healthcare expenses. Case studies are presented, and implications are discussed.


Assuntos
Enfermagem Geriátrica/métodos , Enfermagem Geriátrica/organização & administração , Agências de Assistência Domiciliar/organização & administração , Sistemas Computadorizados de Registros Médicos/organização & administração , Instituições Residenciais/organização & administração , Idoso de 80 Anos ou mais , Feminino , Promoção da Saúde , Humanos , Vida Independente
12.
J Am Med Dir Assoc ; 11(7): 485-93, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20816336

RESUMO

OBJECTIVE: There is growing political pressure for nursing homes to implement the electronic medical record (EMR) but there is little evidence of its impact on resident care. The purpose of this study was to test the unique and combined contributions of EMR at the bedside and on-site clinical consultation by gerontological expert nurses on cost, staffing, and quality of care in nursing homes. METHODS: Eighteen nursing facilities in 3 states participated in a 4-group 24-month comparison: Group 1 implemented bedside EMR, used nurse consultation; Group 2 implemented bedside EMR only; Group 3 used nurse consultation only; Group 4 neither. Intervention sites (Groups 1 and 2) received substantial, partial financial support from CMS to implement EMR. Costs and staffing were measured from Medicaid cost reports, and staff retention from primary data collection; resident outcomes were measured by MDS-based quality indicators and quality measures. RESULTS: Total costs increased in both intervention groups that implemented technology; staffing and staff retention remained constant. Improvement trends were detected in resident outcomes of ADLs, range of motion, and high-risk pressure sores for both intervention groups but not in comparison groups. DISCUSSION: Implementation of bedside EMR is not cost neutral. There were increased total costs for all intervention facilities. These costs were not a result of increased direct care staffing or increased staff turnover. CONCLUSIONS: Nursing home leaders and policy makers need to be aware of on-going hardware and software costs as well as costs of continual technical support for the EMR and constant staff orientation to use the system. EMR can contribute to the quality of nursing home care and can be enhanced by on-site consultation by nurses with graduate education in nursing and expertise in gerontology.


Assuntos
Registros Eletrônicos de Saúde/economia , Casas de Saúde , Admissão e Escalonamento de Pessoal , Qualidade da Assistência à Saúde , Prática Avançada de Enfermagem/organização & administração , Custos e Análise de Custo , Humanos , Missouri , Sistemas Automatizados de Assistência Junto ao Leito , Indicadores de Qualidade em Assistência à Saúde
13.
J Gerontol Nurs ; 36(1): 13-7, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20047248

RESUMO

As in acute care, use of health information technology in long-term care holds promise for increased efficiency, better accuracy, reduced costs, and improved outcomes. A comprehensive electronic health record (EHR), which encompasses all health care measures that clinicians want to use-both standard health care assessments and those acquired through emerging technology-is the key to improved, efficient clinical decision making. New technologies using sensors to passively monitor older adults at home are being developed and are commercially available. However, integrating the clinical information systems with passive monitoring data so that clinical decision making is enhanced and patient records are complete is challenging. Researchers at the University of Missouri (MU) are developing a comprehensive EHR to: (a) enhance nursing care coordination at TigerPlace, independent senior housing that helps residents age in place; (b) integrate clinical data and data from new technology; and (c) advance technology and clinical research.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Sistemas de Apoio a Decisões Clínicas/organização & administração , Registros Eletrônicos de Saúde/organização & administração , Monitorização Ambulatorial/enfermagem , Planejamento de Assistência ao Paciente/organização & administração , Integração de Sistemas , Idoso , Moradias Assistidas , Segurança Computacional , Difusão de Inovações , Enfermagem Geriátrica/organização & administração , Humanos , Internet/organização & administração , Registro Médico Coordenado , Missouri , Registros de Enfermagem , Avaliação da Tecnologia Biomédica , Interface Usuário-Computador
14.
Geriatr Nurs ; 30(4): 238-49, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19665666

RESUMO

The Quality Improvement Program for Missouri (QIPMO), a state school of nursing project to improve quality of care and resident outcomes in nursing homes, has a special focus to help nursing homes identified as "at risk" for quality concerns. In fiscal year 2006, 92 of 492 Medicaid-certified facilities were identified as "at risk" using quality indicators (QIs) derived from Minimum Data Set (MDS) data. Sixty of the 92 facilities accepted offered on-site clinical consultations by gerontological expert nurses with graduate nursing education. Content of consultations include quality improvement, MDS, care planning, evidence-based practice, and effective teamwork. The 60 "at-risk" facilities improved scores 4%-41% for 5 QIs: pressure ulcers (overall and high risk), weight loss, bedfast residents, and falls; other facilities in the state did not. Estimated cost savings (based on prior cost research) for 444 residents who avoided developing these clinical problems in participating "at-risk" facilities was more than $1.5 million for fiscal year 2006. These are similar to estimated savings of $1.6 million for fiscal year 2005 when 439 residents in "at-risk" facilities avoided clinical problems. Estimated savings exceed the total program cost by more than $1 million annually. QI improvements demonstrate the clinical effectiveness of on-site clinical consultation by gerontological expert nurses with graduate nursing education.


Assuntos
Casas de Saúde/normas , Indicadores de Qualidade em Assistência à Saúde , Qualidade da Assistência à Saúde , Redução de Custos , Missouri , Casas de Saúde/economia
16.
J Nurs Meas ; 16(1): 16-30, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18578107

RESUMO

Field test results are reported for the Observable Indicators of Nursing Home Care Quality Instrument-Assisted Living Version, an instrument designed to measure the quality of care in assisted living facilities after a brief 30-minute walk-through. The OIQ-AL was tested in 207 assisted-living facilities in two states using classical test theory, generalizability theory, and exploratory factor analysis. The 34-item scale has a coherent six-factor structure that conceptually describes the multidimensional concept of care quality in assisted living. The six factors can be logically clustered into process (Homelike and Caring, 21 items) and structure (Access and Choice; Lighting; Plants and Pets; Outdoor Spaces) subscales and for a total quality score. Classical test theory results indicate most subscales and the total quality score from the OIQ-AL have acceptable interrater, test-retest, and strong internal consistency reliabilities. Generalizability theory analyses reveal that dependability of scores from the instrument are strong, particularly by including a second observer who conducts a site visit and independently completes an instrument, or by a single observer conducting two site visits and completing instruments during each visit. Scoring guidelines based on the total sample of observations (N = 358) help guide those who want to use the measure to interpret both subscale and total scores. Content validity was supported by two expert panels of people experienced in the assisted-living field, and a content validity index calculated for the first version of the scale is high (3.43 on a four-point scale). The OIQ-AL gives reliable and valid scores for researchers, and may be useful for consumers, providers, and others interested in measuring quality of care in assisted-living facilities.


Assuntos
Casas de Saúde/normas , Avaliação de Processos e Resultados em Cuidados de Saúde/métodos , Indicadores de Qualidade em Assistência à Saúde/normas , Qualidade da Assistência à Saúde/normas , Atitude do Pessoal de Saúde , Comportamento de Escolha , Análise Fatorial , Grupos Focais , Acessibilidade aos Serviços de Saúde , Humanos , Decoração de Interiores e Mobiliário , Iluminação/normas , Missouri , Pesquisa em Avaliação de Enfermagem , Pesquisa Metodológica em Enfermagem , Variações Dependentes do Observador , Avaliação de Processos e Resultados em Cuidados de Saúde/normas , Participação do Paciente , Psicometria , Estatísticas não Paramétricas , Inquéritos e Questionários , Wisconsin
17.
J Gerontol Nurs ; 33(1): 40-7, 2007 01.
Artigo em Inglês | MEDLINE | ID: mdl-17305268

RESUMO

Ongoing problems with nursing home care mandates understanding nursing home staff's perspectives on innovative quality improvement programs. This follow-up study used focus groups to examine the experiences of staff who participated in a clinical trial that involved Quality Indicator (QI) feedback reports, quality improvement training, and APN consultation. The authors found that QI reports provided staff with a benchmark to judge their care and a means to track problems; APN consultation was essential for staff to learn best practices; and staff questioned the validity of the QI reports, which hindered them from seeking new solutions to problems identified in the QI reports. Findings indicate that innovative QI programs and APN consultation can positively influence nursing home quality improvement efforts and improve care.


Assuntos
Atitude do Pessoal de Saúde , Casas de Saúde , Recursos Humanos de Enfermagem/psicologia , Gestão da Qualidade Total/organização & administração , Benchmarking/organização & administração , Coleta de Dados , Educação Continuada em Enfermagem , Grupos Focais , Seguimentos , Enfermagem Geriátrica/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Missouri , Estudos Multicêntricos como Assunto , Enfermeiros Administradores/organização & administração , Enfermeiros Administradores/psicologia , Enfermeiros Clínicos , Casas de Saúde/organização & administração , Pesquisa Metodológica em Enfermagem , Recursos Humanos de Enfermagem/organização & administração , Pesquisa Qualitativa , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Ensaios Clínicos Controlados Aleatórios como Assunto
18.
West J Nurs Res ; 28(8): 918-34, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17099105

RESUMO

This is a methodological article intended to demonstrate the integration of multiple goals, multiple projects with diverse foci, and multiple funding sources to develop an entrepreneurial program of research and service to directly affect and improve the quality of care of older adults, particularly nursing home residents. Examples that illustrate how clinical ideas build on one another and how the research ideas and results build on one another are provided. Results from one study are applied to the next and are also applied to the development of service delivery initiatives to test results in the real world. Descriptions of the Quality Improvement Program for Missouri and the Aging in Place Project are detailed to illustrate real-world application of research to practice.


Assuntos
Empreendedorismo , Pesquisa sobre Serviços de Saúde/organização & administração , Casas de Saúde/organização & administração , Qualidade da Assistência à Saúde , Idoso , Comportamento Cooperativo , Organização do Financiamento , Pesquisa sobre Serviços de Saúde/economia , Humanos , Assistência de Longa Duração , Modelos Organizacionais
19.
J Am Med Dir Assoc ; 7(6): 366-76, 2006 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16843237

RESUMO

PURPOSE: To evaluate a range of staffing measures and data sources for long-term use in public reporting of staffing as a quality measure in nursing homes. METHOD: Eighty-seven research articles and government documents published from 1975 to 2003 were reviewed and summarized. Relevant content was extracted and organized around 3 themes: staffing measures, quality measures, and risk adjustment variables. Data sources for staffing information were also identified. RESULTS: There is a proven association between higher total staffing levels (especially licensed staff) and improved quality of care. Studies also indicate a significant relationship between high turnover and poor resident outcomes. Functional ability, pressure ulcers, and weight loss are the most sensitive quality indicators linked to staffing. The best national data sources for staffing and quality include the Minimum Data Set (MDS) and On-line Survey and Certification Automated Records (OSCAR). However, the accuracy of this self-reported information requires further reliability and validity testing. CONCLUSIONS: A nationwide instrument needs to be developed to accurately measure staff turnover. Large-scale studies using payroll data to measure staff retention and its impact on resident outcomes are recommended. Future research should use the most nurse-sensitive quality indicators such as pressure ulcers, functional status, and weight loss.


Assuntos
Coleta de Dados/métodos , Casas de Saúde/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Atividades Cotidianas , Idoso , Coleta de Dados/normas , Grupos Diagnósticos Relacionados/organização & administração , Avaliação Geriátrica , Pesquisa sobre Serviços de Saúde , Humanos , Pesquisa em Administração de Enfermagem , Assistentes de Enfermagem/provisão & distribuição , Recursos Humanos de Enfermagem/provisão & distribuição , Enfermagem Prática , Avaliação de Resultados em Cuidados de Saúde/organização & administração , Úlcera por Pressão/epidemiologia , Úlcera por Pressão/prevenção & controle , Reprodutibilidade dos Testes , Projetos de Pesquisa , Risco Ajustado/organização & administração , Sensibilidade e Especificidade , Estados Unidos , Redução de Peso , Recursos Humanos
20.
Nurs Outlook ; 53(5): 224-31, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16226566

RESUMO

This article describes the methods that one academic nursing unit used to move from receiving no National Institutes of Health funding to a top-20 ranking. A 1995 school task force recommended changes to move toward greater research productivity, including increased external funding. The school created a research infrastructure to support both the scientific development of research studies and the production of high-quality external grant applications. Barriers to research productivity were successfully managed. The research culture dramatically changed to emphasize innovation, autonomy, peer support and review, long-term investment in research productivity, penetration of research throughout school activities, and public display of research accomplishments. Academic nursing units can develop research cultures to support meaningful research that secures major external funding.


Assuntos
Docentes de Enfermagem/organização & administração , Pesquisa em Enfermagem/organização & administração , Apoio à Pesquisa como Assunto/organização & administração , Difusão de Inovações , Eficiência Organizacional , Humanos , Relações Interprofissionais , Missouri , Modelos Organizacionais , National Institutes of Health (U.S.) , Avaliação das Necessidades , Pesquisa em Enfermagem/educação , Cultura Organizacional , Inovação Organizacional , Grupo Associado , Revisão da Pesquisa por Pares , Autonomia Profissional , Desenvolvimento de Programas , Apoio Social , Desenvolvimento de Pessoal/organização & administração , Estados Unidos
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