Nursing homes with persistent deficiency citations for physical restraint use
Nursing homes with persistent deficiency citations for physical restraint use
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DOI：
10.1097/00005650-200210000-00005
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发表时间：
2002-10-01
期刊：
影响因子：
3
通讯作者：
Castle, NG
中科院分区：
文献类型：
--
作者：
Castle, NG
目标..本研究旨在探讨护养院在使用身体约束时的持续不良品质所具有的组织特征和居民聚集特征。在连续两次和三次认证调查检查中对身体约束使用的不足引用被用作我们的质量不佳的衡量标准。首先，使用1996、1997、1998和1999年在线调查、认证和报告系统中具有全国代表性的数据来提供描述性分析。第二，采用多项Logistic回归分析方法，分别对调查检查、连续两次检查和连续三次检查中存在约束缺陷引用的养老院组织特征和总体特征进行分析。结果显示，729家养老院(5.2%)在两次连续检查中存在约束缺陷引用，317家(2.3%)连续三次检查存在约束缺陷引用。养老院在使用身体约束方面的持续质量低下与护理人员更高的人员水平负相关，与更高的医疗补助人口普查和更高的日常生活平均活动(ADL)水平正相关。结论：疗养院改革法案在降低养老院使用身体约束的总体流行率方面产生了极大的影响，但面对这项立法，在使用约束方面持续存在质量问题的设施数量令人惊讶。这些疗养院的组织和总体居民特征，特别是RN人员配备水平、医疗补助人口普查和平均ADL水平，与那些没有因使用身体约束而收到任何不足传票的疗养院不同。
OBJECTIVES.. This paper examines the organizational and aggregate resident characteristics of nursing homes associated with persistent poor quality in the use of physical restraints. Deficiency citations for physical restraint use in two and three consecutive certification survey inspections are used as our measures of poor quality.MATERIALS AND METHODS. Nationally representative data from the 1996, 1997, 1998, and 1999 Online Survey, Certification, and Reporting system are used, first, to provide descriptive analyses. Second, multinomial logistic regression analyses are used to examine organizational and aggregate resident characteristics associated with deficiency citations for restraint use on any survey inspection, on two consecutive inspections, and deficiencies for physical restraint use in three consecutive inspections.RESULTS. It is shown that 729 (5.2%) nursing homes had, deficiency citations for restraint use, on two consecutive inspections and 317 (2.3%) on three consecutive inspections. Persistent poor quality in the use of physical restraints in nursing homes is negatively associated to higher staffing levels of care givers, and positively associated to higher Medicaid census, and higher average activities of daily living (ADL) levels.CONCLUSION. The Nursing Home Reform Act has been extremely influential in reducing the overall prevalence of physical restraint use in nursing homes, but the number of facilities with persistent quality problems in their use of restraints in the face of this legislation is surprising. The organizational and aggregate resident characteristics of these nursing homes, especially RN staffing levels, Medicaid census, and average ADL levels differ from those that did not receive any deficiency citations for use of physical restraints.