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1.
J Alzheimers Dis ; 2020 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-32390616

RESUMO

BACKGROUND: A clinical quality registry (CQR) for dementia provides benefits to those living with dementia and their carers by improving the quality and experience of care through benchmarking and monitoring patient outcomes. CQRs use data collected to form clinical quality indicators (CQIs) through which variations in clinical processes and outcomes between different services and jurisdictions can be highlighted. OBJECTIVE: This modified Delphi study aimed to develop CQIs for a pilot Australian CQR for dementia and mild cognitive impairment. These CQIs are based on evidence, patient and caregiver experience, and clinician perspectives across the trajectory of care from diagnosis to end-of-life. METHODS: An initial list of indicators from existing dementia registries, academic literature, and clinical practice guidelines was synthesized. A working group of clinicians and registry experts further refined these indicators. A panel of experts comprised of a consumer, a carer, clinicians, consumer organization representatives, and academics. The experts participated in three phases of the modified Delphi study: 1) online survey for scoring importance and validity, 2) a one-day face-to-face discussion, and 3) final survey round to assess importance, validity, and feasibility. RESULTS: The panel assessed 33 CQIs and confirmed a final set of 18 indicators. The CQIs mapped to the domains of quality of diagnosis, quality of management, access to services and supports, and potentially preventable complications. These CQIs will be tested initially in memory clinics and inform the data collection processes for the Australia Dementia Network Registry (ADNet). CONCLUSION: A dementia CQR is fundamental to ongoing monitoring and development of good quality and consistent care across Australia.

2.
Worldviews Evid Based Nurs ; 17(1): 82-91, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31638315

RESUMO

BACKGROUND: Frontline nurse managers influence the implementation of evidence-based practices (EBP); however, there is a need for valid and reliable instruments to measure their leadership behaviors for EBP implementation in acute care settings. AIM: The aim of this study was to evaluate the validity and reliability of the Implementation Leadership Scale (ILS) in acute care settings using two unique nurse samples. METHODS: This study is a secondary analysis of ILS data obtained through two distinct multisite cross-sectional studies. Sample 1 included 200 registered nurses from one large Californian health system. Sample 2 was 284 registered nurses from seven Midwest and Northeast U.S. hospitals. Two separate studies by different research teams collected responses using written and electronic questionnaires. We analyzed each sample independently. Descriptive statistics described individual item, total, and subscale scores. We analyzed validity using confirmatory factor analysis and within-unit agreement (awg). We evaluated factorial invariance using multigroup confirmatory factor analyses and evaluating change in chi-square and comparative fit index values. We evaluated reliability using Cronbach's alpha. RESULTS: Confirmatory factor analyses in both samples provided strong support for first- and second-order factor structure of the ILS. The factor structure did not differ between the two samples. Across both samples, internal consistency reliability was strong (Cronbach's alpha: 0.91-0.98), as was within-unit agreement (awg: 0.70-0.80). LINKING EVIDENCE TO ACTION: Frontline manager implementation leadership is a critical contextual factor influencing EBP implementation. This study provides strong evidence supporting the validity and reliability of the ILS to measure implementation leadership behaviors of nursing frontline managers in acute care. The ILS can help clinicians, researchers, and leaders in nursing contexts assess frontline manager implementation leadership, deliver interventions to target areas needing improvement, and improve implementation of EBP.

3.
Health Serv Res ; 54(6): 1335-1345, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31602639

RESUMO

OBJECTIVE: To assess whether an electronic health record (EHR) portal to enable health information exchange (HIE) between a hospital and three skilled nursing facilities (SNFs) reduced likelihood of patient readmission. SETTING/DATA: Secondary data; all discharges from a large academic medical center to SNFs between July 2013 and March 2017, combined with portal usage records from SNFs with HIE access. DESIGN: We use difference-in-differences to determine whether portal implementation reduced likelihood of readmission over time for patients discharged to HIE-enabled SNFs, relative to those discharged to nonenabled facilities. Additional descriptive analyses of audit log data characterize portal use within enabled facilities. DATA COLLECTION: Encounter-level clinical EHR data were merged with EHR audit log data that captured portal usage in the timeframe associated with a patient transition from hospital to SNF. PRINCIPAL FINDINGS: Declines in likelihood of 30-day readmission were not significantly different for patients in HIE-enabled vs control SNFs (diff-in-diff = 0.022; P = .431). We observe similar null effects with shorter readmission windows. The portal was used for 46 percent of discharges, with significant usage pattern variation within/across facilities. CONCLUSIONS: Implementation of a hospital-SNF EHR portal did not reduce readmissions from enabled SNFs. Emergent HIE use cases need to be better defined and leveraged for design and implementation that generates value in the context of postacute transitions.


Assuntos
Continuidade da Assistência ao Paciente/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Troca de Informação em Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
4.
Med Care Res Rev ; : 1077558719857335, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31218922

RESUMO

Nursing home (NH) care is arguably the most significant financial risk faced by the elderly without long-term care insurance or Medicaid coverage. Annual out-of-pocket expenditures for NH care can easily exceed $70,000. However, our understanding of private-pay prices is limited by data availability. Utilizing a unique data set on NH prices from 2005 through 2010 across eight states, we find that NH price growth has consistently outpaced growth in consumer and medical care prices. After adjusting for geographical and facility differences, for-profit chains charge the lowest prices, independently operated for-profit and nonprofit NHs have similar prices, and nonprofit chains charge the highest prices. Adjusted prices are also likely to be higher when NHs have higher occupancy rates and markets are more concentrated. The significant differences in price across organizational and market structures suggest private-pay prices can be an important factor when evaluating and comparing the value of NH care.

5.
Med Care Res Rev ; 76(3): 315-336, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-29148340

RESUMO

Consistently accounting for more than 50% of the nursing homes in the United States, corporate chains have played an important role in the industry for several decades. However, few studies have explicitly considered the role of chains in measuring competition in nursing home markets. In this study, we use a newly developed database tracking common ownership over a period of nearly two decades to compare chain-adjusted and unadjusted measures of competition at the county and 25 km fixed-radius levels and explore how the differences would affect the assessment of local market structure. On average, the chain-adjusted Herfindahl-Hirschman Indexes (HHIs) are about 0.02 higher than the unadjusted HHIs. Each year, about 20% to 22% of the counties would appear more concentrated when recalculating HHIs accounting for common ownership. Evidence suggests that nursing home chains tend to focus more on expanding access to new markets within a state than to increasing market power within a smaller local market.


Assuntos
Competição Econômica/economia , Competição Econômica/estatística & dados numéricos , Casas de Saúde/economia , Casas de Saúde/estatística & dados numéricos , Propriedade/organização & administração , Humanos , Estados Unidos
6.
J Nurs Scholarsh ; 51(1): 114-124, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30552736

RESUMO

PURPOSE: The purposes of this study were to (a) describe nurse manager (NM) leadership behaviors for evidence-based practice, NM evidence-based practice competencies, and unit climates for evidence-based practice implementation in acute care, and (b) test for differences in NMs' and staff nurses' (RNs') perceptions. DESIGN: A multisite cross-sectional design was used to collect data from a sample of 24 NMs and 553 RNs from 24 adult medical-surgical units in seven U.S. community hospitals. METHODS: Responses were collected using electronic questionnaires, inclusive of the Nurse Manager Evidence-Based Practice Competency Scale (NM only), Implementation Leadership Scale, and Implementation Climate Scale. E-mail reminders and gift card lottery drawings encouraged response. Descriptive statistics described total and subscale scores by role. Differences in perceptions were evaluated using independent t-tests with Bonferroni correction (α = .05). FINDINGS: 23 NMs and 287 RNs responded (95.8% and 51.9% response rates, respectively). NMs reported they were "somewhat competent" in evidence-based practice (M = 1.62 [SD = 0.5]; 0-3 scale). NMs and RNs perceived leadership behaviors (NM: M = 2.73 [SD = 0.46]; RN: M = 2.88 [SD = 0.78]; 0-4 scale) and unit climates for evidence-based practice implementation (NM: M = 2.16 [SD = 0.67]; RN: M = 2.24 [SD = 0.74]; 0-4 scale) as evident to a "moderate extent." RN and NM perceptions differed significantly on the Proactive (p = .01) and Knowledgeable (p < .001) leadership subscales. CONCLUSIONS: Evidence-based practice competencies and leadership behaviors of NMs, and unit climates for evidence-based practice were modest at best and interventions are needed. To close the research to practice gap, future studies should investigate the interplay between social dynamic context factors and implementation strategies to promote uptake of evidence-based practices. CLINICAL RELEVANCE: Critical attention is needed to build organizational capacity for evidence-based practices through development of unit leadership and climate for evidence-based practice to accelerate routine use of evidence-based practices for improving care delivery and patient outcomes. The three instruments described herein provide a foundation for nurse leaders to assess these dynamic context factors and design interventions or programs where there is opportunity for improvement.

7.
Med Care ; 56(12): 994-1000, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30418961

RESUMO

BACKGROUND: Standardization in production is common in multientity chain organizations. Although chains are prominent in the nursing home sector, standardization in care has not been studied. One way nursing home chains may standardize is by controlling the level and mix of staffing in member homes. OBJECTIVES: To examine the extent to which standardization occurred in staffing, its relative presence across different types of chains, and whether facilities became more standardized following acquisition by a chain. RESEARCH DESIGN: We estimated predictors of the difference between facility and chain staffing using Generalized Estimating Equations with 2000-2010 data. SUBJECTS: This study included nursing homes nationally, excluding hospital-based homes and homes in Alaska, Hawaii, and the District of Columbia. MEASURES: Chain ownership was coded from text identifying chain names. Two nurse staffing measures were used: staff hours per resident day and staff mix. RESULTS: Very large for-profit chain nursing homes and large nonprofits had less variation in staff hours per resident day (P<0.001) but greater variation in staffing mix (P<0.001) compared with the chain average nationally. Large for-profit chains and medium nonprofit chains had greater dispersion on staff hours per resident day (P<0.001), while large nonprofit chains had greater dispersion in staffing mix (P<0.001). The difference between facility and chain staffing decreased over time. CONCLUSIONS: The largest chains (for-profit and nonprofit) had less staffing variation compared with national standards, suggesting they were best at implementing corporate practices. Following ownership changes, staffing converged towards chain averages over time, suggesting standardization takes time to implement.


Assuntos
Casas de Saúde/normas , Recursos Humanos de Enfermagem/organização & administração , Recursos Humanos de Enfermagem/estatística & dados numéricos , Propriedade , Admissão e Escalonamento de Pessoal/normas , Humanos , Casas de Saúde/organização & administração , Casas de Saúde/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/organização & administração , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Recursos Humanos
8.
Inquiry ; 55: 46958018787992, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30047810

RESUMO

Specialty care units (SCUs) in nursing homes (NHs) grew in popularity during the 1990s to attract residents while national policies and treatment paradigms changed. Alzheimer disease has consistently been the dominant form of SCU. This study explored the extent to which chain affiliation, which is common among NHs, affected SCU bed designation. Using data from the Online Survey Certification and Reporting (OSCAR) from 1996 through 2010 with 207 431 NH-year observations, we described trends and compared chain-affiliated NHs with independent NHs. Designation of beds for Alzheimer disease SCUs grew from 1996 to 2003 and then declined. At the peak, 19.6% of all NHs had at least one Alzheimer disease SCU bed. In general, chain affiliation promoted Alzheimer disease SCU bed designation across time, chain size, and NH profit status. During the period of largest growth from 1996 to 2003, the likelihood of designation of Alzheimer disease SCU beds was 1.55 percentage points higher among for-profit NHs affiliated with large chains than independent for-profit NHs ( P < .001) and remained 1.28 percentage points higher from 2004 to 2010. However, chain-affiliated NHs generally had a lower percentage of residents with dementia than independent NHs. For example, although for-profit NHs affiliated with large chains had more Alzheimer disease SCU beds, they had nearly 3% fewer residents with dementia than independent NHs ( P < .001). We conclude that organizational decisions to designate beds for Alzheimer disease SCUs may be related to marketing strategies to attract residents since adoption of Alzheimer disease SCUs has fluctuated over time, but did not appear driven by demand.


Assuntos
Doença de Alzheimer/enfermagem , Medicina , Casas de Saúde , Propriedade , Idoso , Idoso de 80 Anos ou mais , Humanos , Estudos Longitudinais , Modelos Estatísticos , Casas de Saúde/economia , Casas de Saúde/organização & administração , Inquéritos e Questionários
9.
Implement Sci ; 13(1): 62, 2018 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-29695302

RESUMO

BACKGROUND: Nurse managers have a pivotal role in fostering unit climates supportive of implementing evidence-based practices (EBPs) in care delivery. EBP leadership behaviors and competencies of nurse managers and their impact on practice climates are widely overlooked in implementation science. The purpose of this study was to examine the contributions of nurse manager EBP leadership behaviors and nurse manager EBP competencies in explaining unit climates for EBP implementation in adult medical-surgical units. METHODS: A multi-site, multi-unit cross-sectional research design was used to recruit the sample of 24 nurse managers and 553 randomly selected staff nurses from 24 adult medical-surgical units from 7 acute care hospitals in the Northeast and Midwestern USA. Staff nurse perceptions of nurse manager EBP leadership behaviors and unit climates for EBP implementation were measured using the Implementation Leadership Scale and Implementation Climate Scale, respectively. EBP competencies of nurse managers were measured using the Nurse Manager EBP Competency Scale. Participants were emailed a link to an electronic questionnaire and asked to respond within 1 month. The contributions of nurse manager EBP leadership behaviors and competencies in explaining unit climates for EBP implementation were estimated using mixed-effects models controlling for nurse education and years of experience on current unit and accounting for the variability across hospitals and units. Significance level was set at α < .05. RESULTS: Two hundred sixty-four staff nurses and 22 nurse managers were included in the final sample, representing 22 units in 7 hospitals. Nurse manager EBP leadership behaviors (p < .001) and EBP competency (p = .008) explained 52.4% of marginal variance in unit climate for EBP implementation. Leadership behaviors uniquely explained 45.2% variance. The variance accounted for by the random intercepts for hospitals and units (p < .001) and years of nursing experience in current unit (p < .05) were significant but level of nursing education was not. CONCLUSION: Nurse managers are significantly related to unit climates for EBP implementation primarily through their leadership behaviors. Future implementation studies should consider the leadership of nurse managers in creating climates supportive of EBP implementation.


Assuntos
Enfermagem Baseada em Evidências/normas , Liderança , Enfermeiras Administradoras/organização & administração , Enfermeiras Administradoras/normas , Recursos Humanos de Enfermagem no Hospital/organização & administração , Adulto , Criança , Clima , Estudos Transversais , Difusão de Inovações , Enfermagem Baseada em Evidências/métodos , Prática Clínica Baseada em Evidências , Feminino , Humanos , Masculino , Enfermeiras Administradoras/psicologia , Recursos Humanos de Enfermagem no Hospital/psicologia , Cultura Organizacional , Qualidade da Assistência à Saúde , Inquéritos e Questionários , Adulto Jovem
10.
BMJ Qual Saf ; 27(6): 464-473, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-28951531

RESUMO

BACKGROUND: Recent efforts to reduce patient infection rates emphasise the importance of safety culture. However, little evidence exists linking measures of safety culture and infection rates, in part because of the difficulty of collecting both safety culture and infection data from a large number of nursing homes. OBJECTIVE: To examine the association between nursing home safety culture, measured with the Nursing Home Survey on Patient Safety Culture (NHSOPS), and catheter-associated urinary tract infection rates (CAUTI) using data from a recent national collaborative for preventing healthcare-associated infections in nursing homes. METHODS: In this prospective cohort study of nursing homes, facility staff completed the NHSOPS at intervention start and 11 months later. National Healthcare Safety Network-defined CAUTI rates were collected monthly for 1 year. Negative binomial models examined CAUTI rates as a function of both initial and time-varying facility-aggregated NHSOPS components, adjusted for facility characteristics. RESULTS: Staff from 196 participating nursing homes completed the NHSOPS and reported CAUTI rates monthly. Nursing homes saw a 52% reduction in CAUTI rates over the intervention period. Seven of 13 NHSOPS measures saw improvements, with the largest improvements for 'Management Support for Resident Safety' (3.7 percentage point increase in facility-level per cent positive response, on average) and 'Communication Openness' (2.5 percentage points). However, these increases were statistically insignificant, and multivariate models did not find significant association between CAUTI rates and initial or over-time NHSOPS domains. CONCLUSIONS: This large national collaborative of nursing homes saw declining CAUTI rates as well as improvements in several NHSOPS domains. However, no association was found between initial or over-time NHSOPS scores and CAUTI rates.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Casas de Saúde , Segurança do Paciente , Gestão da Segurança , Infecções Urinárias/prevenção & controle , Pesquisas sobre Serviços de Saúde , Humanos , Estudos Prospectivos , Gestão da Segurança/organização & administração
11.
J Am Geriatr Soc ; 65(10): 2244-2250, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28846129

RESUMO

OBJECTIVES: To identify facility- and individual-level predictors of nursing home safety culture. DESIGN: Cross-sectional survey of individuals within facilities. SETTING: Nursing homes participating in the national Agency for Healthcare Research and Quality Safety Program for Long-Term Care: Healthcare-Associated Infections/Catheter-Associated Urinary Tract Infections Project. PARTICIPANTS: Responding nursing home staff (N = 14,177) from 170 (81%) of 210 participating facilities. MEASUREMENTS: Staff responses to the Nursing Home Survey on Patient Safety Culture (NHSOPS), focused on five domains (teamwork, training and skills, communication openness, supervisor expectations, organizational learning) and individual respondent characteristics (occupation, tenure, hours worked), were merged with data on facility characteristics (from the Certification and Survey Provider Enhanced Reporting): ownership, chain membership, percentage residents on Medicare, bed size. Data were analyzed using multivariate hierarchical models. RESULTS: Nursing assistants rated all domains worse than administrators did (P < .001), with the largest differences for communication openness (24.3 points), teamwork (17.4 points), and supervisor expectations (16.1 points). Clinical staff rated all domains worse than administrators. Nonprofit ownership was associated with worse training and skills (by 6.0 points, P =.04) and communication openness (7.3 points, P =.004), and nonprofit and chain ownership were associated with worse supervisor expectations (5.2 points, P =.001 and 3.2 points, P =.03, respectively) and organizational learning (5.6 points, P =.009 and 4.2 points, P = .03). The percentage of variation in safety culture attributable to facility characteristics was less than 22%, with ownership having the strongest effect. CONCLUSION: Perceptions of safety culture vary widely among nursing home staff, with administrators consistently perceiving better safety culture than clinical staff who spend more time with residents. Reporting safety culture scores according to occupation may be more important than facility-level scores alone to describe and assess barriers, facilitators, and changes in safety culture.


Assuntos
Instituição de Longa Permanência para Idosos/organização & administração , Papel do Profissional de Enfermagem/psicologia , Casas de Saúde/organização & administração , Recursos Humanos de Enfermagem/psicologia , Cultura Organizacional , Propriedade/organização & administração , Segurança do Paciente , Gestão da Segurança/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos
12.
Infect Control Hosp Epidemiol ; 38(3): 287-293, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27917728

RESUMO

OBJECTIVE The impact of healthcare system integration on infection prevention programs is unknown. Using catheter-associated urinary tract infection (CAUTI) prevention as an example, we hypothesize that US Department of Veterans Affairs (VA) nursing homes have a more robust infection prevention infrastructure due to integration and centralization compared with non-VA nursing homes. SETTING VA and non-VA nursing homes participating in the AHRQ Safety Program for Long-Term Care collaborative. METHODS Nursing homes provided baseline information about their infection prevention programs to assess strengths and gaps related to CAUTI prevention via a needs assessment questionnaire. RESULTS A total of 353 of 494 nursing homes from 41 states (71%; 47 VA and 306 non-VA facilities) responded. VA nursing homes reported more hours per week devoted to infection prevention-related activities (31 vs 12 hours; P<.001) and were more likely to have committees that reviewed healthcare-associated infections. Compared with non-VA facilities, a higher percentage of VA nursing homes reported tracking CAUTI rates (94% vs 66%; P<.001), sharing CAUTI data with leadership (94% vs 70%; P=.014) and with nursing personnel (85% vs 56%, P=.003). However, fewer VA nursing homes reported having policies for appropriate catheter use (64% vs 81%; P=.004) and catheter insertion (83% vs 94%; P=.004). CONCLUSIONS Among nursing homes participating in an AHRQ-funded collaborative, VA and non-VA nursing homes differed in their approach to CAUTI prevention. Best practices from both settings should be applied universally to create an optimal infection prevention program within emerging integrated healthcare systems. Infect Control Hosp Epidemiol 2017;38:287-293.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Infecção Hospitalar/prevenção & controle , Controle de Infecções/métodos , Casas de Saúde/normas , Infecções Urinárias/prevenção & controle , Humanos , Liderança , Modelos Logísticos , Análise Multivariada , Casas de Saúde/estatística & dados numéricos , Recursos Humanos de Enfermagem , Guias de Prática Clínica como Assunto , Administração da Prática Médica , Inquéritos e Questionários , Estados Unidos , United States Department of Veterans Affairs
13.
Health Aff (Millwood) ; 35(5): 907-14, 2016 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-27140998

RESUMO

Two defining features of the nursing home industry are the tremendous churn in chain ownership and the perception of low-quality care at many facilities. We examined whether nursing homes that underwent chain-related transactions, such as mergers and acquisitions, experienced a larger number of health deficiency citations than nursing homes that maintained common ownership over the same period. Using facility-level data for the period 1993-2010, we found that those nursing homes that underwent chain-related transactions had more deficiency citations in the years preceding and following a transaction than those nursing homes that maintained common ownership. Thus, we did not find that these transactions led to a decline in quality. Instead, we found that chains targeted nursing homes that were already having quality problems and that these problems persisted after the transaction. Given the high frequency of nursing home chain transactions, policy makers will need to continue to invest in tracking, reporting, and overseeing these transactions. One important step would be to report more detailed data on chain ownership, transactions, and aggregate chain quality on the Nursing Home Compare website, the federal government's online report card for nursing homes.


Assuntos
Instituições Associadas de Saúde/estatística & dados numéricos , Casas de Saúde/tendências , Propriedade/economia , Qualidade da Assistência à Saúde/normas , Humanos , Estudos Longitudinais , Casas de Saúde/organização & administração , Propriedade/estatística & dados numéricos , Inquéritos e Questionários
14.
Med Care ; 54(3): 229-34, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26765147

RESUMO

BACKGROUND: In 2012, over half of nursing homes were operated by corporate chains. Facilities owned by the largest for-profit chains were reported to have lower quality of care. However, it is unknown how nursing home chain ownerships are related with experiences of care. OBJECTIVES: To study the relationship between nursing home chain characteristics (chain size and profit status) with patients' family member reported ratings on experiences with care. DATA SOURCES AND STUDY DESIGN: Maryland nursing home care experience reports, the Online Survey, Certification, And Reporting (OSCAR) files, and Area Resource Files are used. Our sample consists of all nongovernmental nursing homes in Maryland from 2007 to 2010. Consumer ratings were reported for: overall care; recommendation of the facility; staff performance; care provided; food and meals; physical environment; and autonomy and personal rights. We identified chain characteristics from OSCAR, and estimated multivariate random effect linear models to test the effects of chain ownership on care experience ratings. RESULTS: Independent nonprofit nursing homes have the highest overall rating score of 8.9, followed by 8.6 for facilities in small nonprofit chains, and 8.5 for independent for-profit facilities. Facilities in small, medium, and large for-profit chains have even lower overall ratings of 8.2, 7.9, and 8.0, respectively. We find similar patterns of differences in terms of recommendation rate, and important areas such as staff communication and quality of care. CONCLUSIONS: Evidence suggests that Maryland nursing homes affiliated with large-for-profit and medium-for-profit chains had lower ratings of family reported experience with care.


Assuntos
Instituições Privadas de Saúde/organização & administração , Instituições Privadas de Saúde/estatística & dados numéricos , Casas de Saúde/organização & administração , Casas de Saúde/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Meio Ambiente , Serviços de Alimentação/normas , Serviços de Alimentação/estatística & dados numéricos , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Humanos , Assistência de Longa Duração , Maryland , Organizações sem Fins Lucrativos/organização & administração , Organizações sem Fins Lucrativos/estatística & dados numéricos , Direitos do Paciente , Autonomia Pessoal , Admissão e Escalonamento de Pessoal , Qualidade da Assistência à Saúde/estatística & dados numéricos , Características de Residência , Fatores Socioeconômicos
15.
Gerontologist ; 55(3): 462-71, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24218146

RESUMO

PURPOSE OF THE STUDY: We examined how organizational culture in nursing homes affects staff turnover, because culture is a first step to creating satisfactory work environments. DESIGN AND METHODS: Nursing home administrators were asked in 2009 to report on facility culture and staff turnover. We received responses from 419 of 1,056 administrators contacted. Respondents reported the strength of cultural values using scales from a Competing Values Framework and percent of staff leaving annually for Registered Nurse (RN), Licensed Practice Nurse (LPN), and nursing aide (NA) staff. We estimated negative binomial models predicting turnover. RESULTS: Turnover rates are lower than found in past but remain significantly higher among NAs than among RNs or LPNs. Facilities with stronger market values had increased turnover among RNs and LPNs, and among NAs when turnover was adjusted for facilities with few staff. Facilities emphasizing hierarchical internal processes had lower RN turnover. Group and developmental values focusing on staff and innovation only lowered LPN turnover. Finally, effects on NA turnover become insignificant when turnover was adjusted if voluntary turnover was reported. IMPLICATIONS: Organizational culture had differential effects on the turnover of RN, LPN, and NA staff that should be addressed in developing culture-change strategies. More flexible organizational culture values were important for LPN staff only, whereas unexpectedly, greater emphasis on rigid internal rules helped facilities retain RNs. Facilities with a stronger focus on customer needs had higher turnover among all staff.


Assuntos
Instituição de Longa Permanência para Idosos/organização & administração , Casas de Saúde/organização & administração , Recursos Humanos de Enfermagem/provisão & distribução , Cultura Organizacional , Reorganização de Recursos Humanos , Feminino , Humanos , Enfermeiras e Enfermeiros , Inquéritos e Questionários , Estados Unidos
16.
J Am Geriatr Soc ; 61(11): 1909-18, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24219192

RESUMO

OBJECTIVES: To explore patterns of change in nursing home (NH) residents' activities of daily living (ADLs), particularly surrounding acute hospital stays. DESIGN: Longitudinal study using Medicare and Minimum Data Set (MDS) assessments. SETTING: National sample of long-stay NH residents. PARTICIPANTS: NH residents who were hospitalized for the seven most-common inpatient diagnoses (N = 40,128). Each hospital admission was at least 90 days after any prior hospitalization and had at least two preceding MDS assessments. MEASUREMENTS: The MDS ADL long-form score, a simple sum of seven self-care variables coded from 0 (independent) to 4 (totally dependent) was used to indicate resident ADL function. Scores ranged from 0 to 28, with higher scores indicating greater impairment. A linear mixed model describing ADL trajectories was jointly estimated with time-to-event models for mortality and hospital readmission. RESULTS: Before hospitalization, the most common trajectory was stable (53.7%), with 27.5% of residents worsening and 18.8% improving. ADL function after hospital discharge was most often characterized as stable (43.1%) or worsening (39.2%). Mortality (20.3%) was higher for those with worsening prehospital ADL function (28.9%) than for those with stable (19.1%) or improving (11.3%) trajectories. Hospital diagnosis was associated with amount of ADL worsening and rate of subsequent ADL change. Most residents with the best initial function continued to worsen after hospital discharge. Cognitive impairment was associated with poorer ADL function and accelerated worsening of ADLs. CONCLUSION: For many long-stay NH residents, substantial and sustained ADL worsening accompanies acute hospitalization, so acute hospitalization presents an opportunity to revisit care goals; the results of the current study can help inform decision-making.


Assuntos
Atividades Cotidianas , Hospitalização/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Recuperação de Função Fisiológica , Fatores de Tempo
17.
J Healthc Manag ; 58(3): 187-203; discussion 203-4, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23821898

RESUMO

Knowledge management (KM) is emerging as an important aspect of achieving excellent organizational performance, but its use has not been widely explored for hospitals. Taking a positive deviance perspective, we analyzed the applications of nine healthcare organizations (HCOs) that received the Malcolm Baldrige National Quality Award from 2002 to 2008. Baldrige Award applications constitute a uniquely comprehensive, standardized, and audited record of HCOs achieving near-benchmark performance. Applications are organized around leadership, strategy, customers, information, workforce, and operations. We find that KM is frequently referenced in all sections, and about two thirds of each application addresses KM-related issues. Many specific KM activities, such as strategic and action plans, communications, and processes to capture internal and external knowledge, are addressed by all nine applications. We present examples illustrating these frequently appearing KM concepts. Baldrige Award-recipient HCOs apply continuous improvement to KM processes, as they do to their organizations as a whole. We conclude that these HCOs have developed sophisticated, comprehensive KM processes to align both culture and specific procedures throughout the organization. KM in these organizations is a deliberate effort to keep all relevant knowledge at the fingertips of every worker, characterized by frequent communication, careful maintenance of content accuracy, and redundant distribution. We also conclude that the extent and rigor of their KM practice distinguish them from other U.S. hospitals.


Assuntos
Distinções e Prêmios , Administração Hospitalar , Gestão do Conhecimento , Humanos , Gestão do Conhecimento/estatística & dados numéricos , Estados Unidos
18.
Med Care ; 51(8): 659-65, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23632596

RESUMO

OBJECTIVE: Within Veterans Affairs (VA) nursing homes (NHs), quality issues have a tremendous impact on the population with serious mental illness (SMI), who are more likely than their non-SMI Veteran counterparts to use NH services. We examined recent trends in quality indicators (QIs) measuring poor performance of VA NHs and whether the facility-level QIs vary with SMI concentration within the facility. METHODS: From VA administrative records including Minimum Data Set assessments, we identified all residents in the 135 VA NHs between fiscal years 2005 (FY05) through FY07. We used a zero-inflated Poisson regression to assess trends in and facility-level predictors of 3 process-related QIs: depression without antidepressant therapy; bladder/bowel incontinence without a toileting plan; and physical restraint use. Facility-level predictors included collocated special care units, rurality, staffing, physical plant characteristics, SMI prevalence, and SMI admission volume. RESULTS: During FY05-FY07, restraint use declined from 1.2% to 1.1% and incontinence without a toileting plan from 25.8% to 22.1%, but untreated depression increased from 5.1% to 5.5%. Despite overall gains in quality, higher SMI prevalence was associated with higher odds of physical restraint use and lack of toileting plan. Higher SMI prevalence was also associated with higher frequency of untreated depression. Other characteristics such as complex building structure were predictive of variation in quality, but the relationships were not consistent across QI types. CONCLUSION: VA NHs had significant improvements in these examined QIs during the study period. Nonetheless, overall poorer quality was observed at sites with higher SMI concentrations.


Assuntos
Instituição de Longa Permanência para Idosos/organização & administração , Transtornos Mentais/epidemiologia , Casas de Saúde/organização & administração , Qualidade da Assistência à Saúde/estatística & dados numéricos , United States Department of Veterans Affairs/organização & administração , Depressão/terapia , Meio Ambiente , Previsões , Instituição de Longa Permanência para Idosos/normas , Humanos , Casas de Saúde/normas , Admissão e Escalonamento de Pessoal , Indicadores de Qualidade em Assistência à Saúde , Qualidade da Assistência à Saúde/tendências , Características de Residência , Restrição Física/estatística & dados numéricos , Estados Unidos , Incontinência Urinária/terapia
19.
Health Care Manage Rev ; 38(4): 295-305, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-22936002

RESUMO

BACKGROUND: Culture change initiatives propose to improve care by addressing the lack of managerial supports and prevalent stressful work environments in the industry; however, little is known about how culture change facilities differ from facilities in the industry that have not chosen to affiliate with the resident-centered care movements. PURPOSE: The aim of this study was to evaluate representation of organizational culture values within a random sample of U.S. nursing home facilities using the competing values framework and to determine whether organizational values are related to membership in resident-centered culture change initiatives. DESIGN AND METHODS: We collected reports of cultural values using a well-established competing values framework instrument in a random survey of facility administrators and directors of nursing within all states. We received responses from 57% of the facilities that were mailed the survey. Directors of nursing and administrators did not differ significantly in their reports of culture and facility measures combined their responses. FINDINGS: Nursing facilities favored market-focused cultural values on average, and developmental values, key to innovation, were the least common across all nursing homes. Approximately 17% of the facilities reported that all cultural values were strong within their facilities. Only high developmental cultural values were linked to participation in culture change initiatives. Culture change facilities were not different from non-culture change facilities in the promotion of employee focus as organizational culture, as emphasized in group culture values. Likewise, culture change facilities were also not more likely to have hierarchical or market foci than non-culture change facilities. PRACTICE IMPLICATIONS: Our results counter the argument that culture change facilities have a stronger internal employee focus than facilities more generally but do show that culture change facilities report stronger developmental cultures than non-culture change facilities, which indicates a potential to be innovative in their strategies. Facilities are culturally ready to become resident centered and may face other barriers to adopting these practices.


Assuntos
Casas de Saúde/organização & administração , Cultura Organizacional , Inovação Organizacional , Assistência Centrada no Paciente/organização & administração , Atitude do Pessoal de Saúde , Coleta de Dados , Administradores de Instituições de Saúde , Humanos , Valores Sociais , Estados Unidos
20.
Health Educ Behav ; 38(6): 617-28, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21482703

RESUMO

Genetic testing can advance cancer prevention if current screening behaviors improve. Increased prevalence of high-risk genotypes within specific religious groups, use of religious venues for recruiting to genetic screening, and ethical-religious considerations argue for exploring the role of religiosity in forming genetic testing decisions. This study uses the theory of reasoned action and structural equation modeling to test the effects of religious involvement, attitudes, knowledge, and previous experience on intent-to-obtain genetic testing within a representative sample of 1,824 U.S. adults. A majority of respondents indicate willingness to test, especially for curable disorders. Attitudes, knowledge, and previous experience have significant direct effects, and religious involvement has an indirect effect, through its negative effect on attitudes, on intent-to-test. High religious involvement is associated with more negative attitudes toward genetic testing. The findings underscore the need to refine genetic testing outreach efforts to account for multiple influences on consumer intent-to-test.


Assuntos
Testes Genéticos , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Neoplasias/genética , Religião e Medicina , Adulto , Afro-Americanos , Catolicismo/psicologia , Grupo com Ancestrais do Continente Europeu , Análise Fatorial , Predisposição Genética para Doença/etnologia , Predisposição Genética para Doença/psicologia , Inquéritos Epidemiológicos , Humanos , Intenção , Judeus/genética , Judeus/psicologia , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Neoplasias/prevenção & controle , Estados Unidos
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