Quality Of Care In Nursing Homes Research Articles

Establishing customer relationship management framework in nursing homes

The population of Taiwan has aged rapidly during the mid-1980s, and Taiwan formally became an ageing society in 1993. The elderly population of Taiwan reached 9.09% of the total population in April 2003. A significant need exists for medical and long-term care services for this aged population, especially nursing homes with professional care services. Consequently, nursing home care quality has become a major issue in Taiwan. This study establishes a customer relationship management (CRM) framework for nursing homes. CRM in nursing homes involves three aspects, namely case management customer relationships, information management customer relationships, and care management customer relationships. CRM in a nursing homes is further divided into nine sub-phases: interactive mechanism, assessment of demand model, customer data collection, data analysis, knowledge management, care design, care delivery, support from the related units, monitoring and feedback. This study also ranked the sequence of 84 indicators of CRM based on their importance. Focusing on these indicators can enable a nursing home to effectively improve its care quality.

STABILITY AND SENSITIVITY OF NURSING HOME QUALITY INDICATORS

HE issues of stability and sensitivity of indicators toactually detect differences in quality of care in nursingfacilities are not only of concern to researchers, but alsoto public policy makers, who are reporting indicators toproviders and now to consumers. Our research team at theUniversityofMissouri-Columbiarecentlycompletedastudyof 92 randomly selected nursing homes with a range ofquality. Quality of care measurement was based ona statewide analysis of 23 quality indicators (QIs) currentlyused by the federal government to evaluate quality of care innursing homes (see Table 1). The study examined the cost,staffing, and quality of care information from the nursinghome Minimum Data Set (MDS) and Medicaid cost reportlarge data sets with processes of care data collected fromon-site participant observations of each facility (1). Thisresearch brief explains what we learned in our study aboutstability and sensitivity of the MDS QIs.B

Bereaved family members' perceptions of end-of-life cancer care in nursing homes, hospices with home care, and acute care hospitals

8052 Background: Nursing homes (NH) are increasingly the last place of care (LPOC) and site of death for persons with cancer. Little is known about the quality of care in NH for terminally ill cancer patients. Based upon a study of dying experiences, we examined the quality of end-of-life cancer care (EOLCC) for patients in NH, at home with hospice, and in acute care hospitals. Methods: A national mortality follow-back survey was conducted via telephone interviews with a family member or knowledgeable informant of the decedent (n=1578, 65% cooperation rate). Interviewers asked if health care workers provided the desired physical comfort and emotional support to the dying person, treated the dying person with respect, supported shared decision-making, coordinated care, and provided emotional support to the family. Chi-Square test was used to examine bereaved family members' perceptions of the LPOC. Results: 427 of 1578 patients (27.1%) died from cancer. For the LPOC, 19.3% died at a NH (41.8% home with hospice, 38.9% hospitals). Decedents in NH had greater unmet needs with pain and anxiety (p<0.1). 29.8% of respondents felt that NH staff had insufficient knowledge of the patient's medical history to provide highest quality EOLCC (7.2% home with hospice, 10.1% hospitals, p<.01). 32% of respondents stated that NH staff did not treat the patient with respect (2.6% home with hospice, 20.6% hospitals, p<.01). About 50% of respondents for both NH and hospitalized patients felt they were inadequately educated by staff about the dying process (30.6% home with hospice, p=.01). Respondents' overall satisfaction was lowest for NH (44% “excellent”) compared to home with hospice and hospitals (67.0%, 58.4%, p<.01). Conclusions: NH were consistently rated less favorably by bereaved family members than were home with hospice services and acute care hospitals for providing quality EOLCC. While challenging, opportunities to improve EOLCC should be sought, recognized and pursued in all settings. Oncologists have an important and central role in coordinating these efforts. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Robert Wood Johnson Foundation

Towards an ideal skill mix in nursing homes.

The quality of care provided by staff to residents in nursing homes and the residents’ quality of life are influenced by many factors, but staffing levels and staffing characteristics such as grade mix are vital. For quality nursing home care it is generally accepted that a workforce is needed of a sufficient size with the necessary skills, competence, commitment, attitudes and values. Staff should be supported by education and training, supervision, leadership, management and appropriate environmental conditions. The Department of Health (DoH) is preparing guidance on registered nurse (RN) staffing, and DoH-funded work on RN staffing was recently undertaken by the Residential Forum, which promotes the achievement of high standards of care for children and adults in nursing homes, residential homes and schools, but this has not yet been published. In the absence of guidance since the implementation of the Care Standards Act 2000, homes are working to the staffing notices issued by Registration and Inspection Authorities under the Registered Homes Act 1984. These generally translate as: am shift: one member of staff to five residents pm shift: 1: 6/7 night shift: 1:10. Of these, the skill mix is generally 30 per cent RNs to 70 per cent care assistants. This article presents a review of some of the available literature that nursing home managers and commissioners of nursing home services may find useful in determining an appropriate skill mix for such services.

Relationship of Nursing Personnel and Nursing Home Care Quality

The purpose of this study was to examine the associations between nurse staffing hours and 6 quality indicators: physical restraints, weight loss, incontinence, late loss activities of daily living decline, stages 1 to 4 pressure ulcers, and problem behaviors toward others. Increasing registered nurse staff hours may achieve better quality indicator scores for pressure ulcers. An increase in nurse aide hours should be carefully weighed with the amount of registered nurse staff time available for supervision and direction.

Developing a Residential Care Facility Version of the Observable Indicators of Nursing Home Care Quality Instrument

The last decade has seen a substantial growth in the development of residential care facilities (assisted living facilities). Evaluation of the quality of care in this service delivery sector has been hampered by the lack of a consensus definition of quality and the lack of reliable instruments to measure quality. Founded on extensive research on nursing home care quality, a field test of the Residential Care Facility Version of the Observable Indicators of Nursing Home Care Quality Instrument was conducted in 35 residential care facilities in Missouri. Content validity of the 34 items was rated by 4 expert raters as 3.4 on a 4-point scale of relevance. Test-retest was 0.94, interrater reliability was 0.73, and internal consistency was 0.90 for the total scale, indicating excellent results for initial field-testing. A focus group confirmed the 5 dimensions of quality of care measured by the instrument as important in residential care settings.

Quality report cards and nursing home quality.

This study examined the potential role that publicly disseminated quality report cards can play in improving quality of care in nursing homes. We review the literature and the experience gained over the last two decades with report cards for hospitals, physicians, and health plans, and consider the issues that are of particular importance in the context of nursing home care. Experience with report cards in other areas of the health care system suggests that nursing home quality reports may have a role to play in informing consumers' choices and providing incentives for quality improvement. Their impact may, however, not be large. Methodological issues that may limit the accuracy of quality indicators and issues related to the design and comprehension of the information by consumers are discussed. Quality report cards should be viewed as one of several options to ensure higher quality nursing home care.

Improving nursing home quality of care through outcomes data: the MDS quality indicators.

The quality of care provided to nursing home residents is a continuing source of concern throughout the world. In the United States, the Health Care Financing Administration mandated the use of a standardised resident assessment instrument, called the Minimum Data Set (MDS) which facilitated the development of a set of nursing home quality of care indicators. The MDS Quality Indicators were developed by a team of researchers at the University of Wisconsin-Madison and covered 12 domains, as well as associated risk factors. This initial set of indicators then went through an iterative process of review by national clinical panels, further empirical analysis, validation studies, and pilot tests, to confirm whether they were accurate, reliable and useful tools for identifying quality problems. The final set of MDS Quality Indicators includes 24 variables that include both processes and outcomes of care and prevalence and incidence measures. They are defined at both the resident and facility level. Four of the indicators are risk-adjusted. The indicators have several possible applications: a source of consumer information; to help guide policy makers; and to assist providers in conducting quality improvement initiatives and to evaluate the impact of these efforts.

International field test results of the Observable Indicators of Nursing Home Care Quality instrument.

Researchers at the University of Missouri-Columbia developed the Observable Indicators of Nursing Home Care Quality instrument to measure the dimensions of nursing home care quality during a brief on-site visit to a nursing home. The instrument has been translated for use in Iceland and used in Canada. Results of the validity and reliability studies using the instrument in 12 nursing homes in Reykjavik, in a large Veterans Home in Ontario with 14 units tested separately, and in 20 nursing homes in Missouri, are promising. High-content validity was observed in all countries, together with excellent inter-rater reliability and coefficient alpha. Test-retest reliabilities in Iceland and Missouri were good. Results of the international field test of the Observable Indicators of Nursing Home Care Quality instrument points to the usefulness of such an instrument in measuring nursing home care quality following a quick on-site observation in a nursing facility. The instrument should be used as a facility-wide assessment of quality, rather than for individual units within a facility. We strongly recommend its use by practising nurses in nursing homes to assess quality of care and guide efforts to improve care. We recommend its use by researchers and consumers and further testing of the use of the instrument with regulators.

Initial Field Testing of an Instrument to Measure: Observable Indicators of Nursing Home Care Quality

The "Observable Indicators of Nursing Home Care Quality" instrument was developed as a new measure of nursing home care quality. The instrument is based on a theoretical model of quality nursing home care grounded in data from provider and consumer focus groups. The instrument was piloted in 10 Missouri nursing homes. Subsequent versions were tested in 109 Missouri and 11 Icelandic nursing homes. Content validity was established using experts. Concurrent and known groups validity was evaluated using Minimum Data Set quality indicators, survey citations, and a process of care measure. Interrater and test-retest reliabilities were calculated as well as coefficient alpha. The "Observable Indicators of Nursing Home Care Quality" instrument is a new measure that can be used by researchers, and potentially by regulators, consumers, or providers, to observe and score specific indicators of quality care following a 20- to 30-minute inspection of a nursing home.

Soil, seed and climate: developing a strategy for prevention and management of infections in UK nursing homes

Most studies of nursing home (NH) infections come from the USA and very few from the UK. USA studies lead us to anticipate a rate of 7 infections per 1000 patient days with a point prevalence as high as 16% in UK NH residents. Pneumonia, skin and urine infections would be the most frequent, followed by enteric infection and bacteraemia. Colonization with resistant organisms is increasing in UK NH residents (e.g., MRSA in 4–17%). Surveillance studies are needed in UK NHs to report incidence of infection, residents' characteristics, existence of and adherence to above standards and policies. Trials of effectiveness of different infection control programmes and of NH vs hospital management are required. Management of infection may be a useful marker of quality of care in NHs and therefore of interest to health and local authorities.

Nursing home care quality: a multidimensional theoretical model integrating the views of consumers and providers.

This exploratory study was undertaken to discover the defining dimensions of nursing home care quality from the viewpoint of consumers of nursing home care. Eleven focus groups were conducted in five Missouri communities. The seven dimensions of the consumer multidimensional model of nursing home care quality are: staff, care, family involvement, communication, environment, home, and cost. The views of consumers and families are compared with the results of a previous study of providers of nursing home services. An integrated, multidimensional theoretical model is presented for testing and evaluation. An instrument based on the model is being tested to observe and score the dimensions of nursing home care quality.

Nursing home care quality: a multidimensional theoretical model.

This exploratory study was undertaken to discover the defining dimensions of nursing home care quality and to propose a conceptual model to guide nursing home quality research and the development of instruments to measure nursing home care quality. Three focus groups were conducted in three central Missouri communities. A naturalistic inductive analysis of the transcribed content was completed. Two core variables (interaction and odor) and several related concepts emerged from the data. Using the core variables, related concepts, and detailed descriptions from participants, three models of nursing home care quality emerged from the analysis: (1) a model of a nursing home with good quality care; (2) a model of a nursing home with poor quality care; and (3) a multidimensional model of nursing home care quality. The seven dimensions of the multidimensional model of nursing home care quality are: central focus, interaction, milieu, environment, individualized care, staff, and safety. To pursue quality, the many dimensions must be of primary concern to nursing homes. We are testing an instrument based on the model to observe and score the dimensions of nursing home care quality.

Verifying nursing home care quality using minimum data set quality indicators and other quality measures.

Researchers, providers and government agencies have devoted time and resources to the development of a set of Quality Indicators derived from Minimum Data Set (MDS) data. Little effort has been directed toward verifying that Quality Indicators derived from MDS data accurately measure nursing home quality. Researchers at the University of Missouri-Columbia have independently verified the accuracy of QI derived from MDS data using four different methods; 1) structured participative observation, 2) QI Observation Scoring Instrument, 3) Independent Observable Indicators of Quality Instrument, and 4) survey citations. Our team was able to determine that QIs derived from MDS data did differentiate nursing homes of good quality from those of poorer quality.

Transition of the Hospice Patient to the Nursing Home

The Hospice Concept is to care for terminally ill pa- tients in their home, providing symptom control, pain rehef, and emotional support; The palien1 is allowed 10 die at home if helshe chooses, which most patients do. As willing as famil caregivers are to provide 24 hour care, this sometimes becomes d ifficult and ex- hausting. Until recently, although nursing home care was available, it was often prohihitive financially. Recent legislation now allows qualified hospices to become Medicare Certified providing quality nursing home care to those patients who qualify for Medicare Insur- ance. This places IheActivity Director in an important role as part of the extended Hospice Team.

Nursing home employment: the nurse's aide's perspective.

1. Nurse's aides are an essential component of quality nursing home care. This study explores some of their opinions about their employment. 2. Despite the many individual demographic differences, the findings of this study indicate that nurse's aides as a group hold many similar opinions about what they like and dislike about their jobs. 3. Multiple factors affect the attitudes of nurse's aides toward their employment. 4. The findings of this study indicate that attachment to others (residents, co-workers) and a sense of personal gratification in the work itself are major themes associated with both retention and morale of nurse's aides.

The influence of registered nurse staffing on the quality of nursing home care

The purpose of this study was to determine the extent to which registered nurse (RN) staffing patterns influenced nursing home quality. Based upon extensive literature review, a model for nursing home quality was developed. Using data from reports of 455 Medicare-certified skilled nursing facilities, structural, process, and outcome factors thought to influence quality were entered into the model and analyzed using ordinary least squares regression. A small, though statistically significant, proportion of the variance in quality nursing home care was explained by the equation. A positive, significant relationship existed between nursing home quality and the ratio of RN hours to licensed vocational nurse (LVN) hours per resident day.

Prospective and ‘cost-plus’ medicaid reimbursement, excess medicaid demand, and the quality of nursing home care

This paper hypothesizes that the Medicaid reimbursement payment discourages quality nursing home care in markets with excess demand. It further shows that an increase in the propective payment or an increase in the return on capital portion of a retrospective cost-plus payment decreases the quality provided when there is excess demand. Finally, it argues that excess demand destroys a costless signal of quality, namely, the degree of excess capacity in a home, making it more difficult for uninformed consumers to make accurate choices and resulting in markets exhibiting the characteristics of adverse selection. These hypotheses are tested using Wisconsin data.

Enforcement of quality nursing home care in the legal system.

In the mid-1970s the alarming state of nursing home care in the United State was dramatically exposed by the Subcommittee on Long-Term Care of the special Committee on Aging of the United States Senate, which released a series of papers collectively entitledNursing Home Care in the United States: Failure in Public.Simultaneously a plethora of media investigations, exposés in the popular literature, scholarly articles, and state commission reports condemned conditions in nursing homes and called for reform. These investigations and reports uniformly demanded more rigorous government regulation of nursing homes. In response, in the late 1970s and early 1980s, virtually all of the states adopted some form of nursing home reform legislation. The federal government also adopted regulations mandating oversight of long-term care facilities participating in the Medicare and Medicaid programs.