Team Performance and Quality of Care in Nursing Homes

描述（由申请人提供）：本研究的目的是评估养老院团队的表现，并探讨团队表现对病人护理结果的影响。在疗养院以外的环境中进行的研究表明，团队绩效与风险调整后的患者结果之间存在很强的关系。如果这种关系可以在养老院记录下来，那么通过识别和传播关于模型团队实践的信息，就有很大的潜力来提高病人护理的质量。分析的概念模型以Donabedian提出的质量范式和肖恩的因果模型为基础。这项研究将在纽约州的375家养老院中随机抽取样本，预计参与率为60%。护理质量将根据三个结果进行评估——功能状态、压疮和尿失禁。团队绩效将从六个方面来衡量——领导力、沟通、协调、冲突管理、团队凝聚力和团队效率。主要数据将通过调查和访谈获得。次要数据将包括最小数据集（MDS）、在线调查认证和报告系统（OSCAR）和区域资源文件（ARF）。数据分析将包括多元回归技术，以检验关于团队绩效的特定假设，以及团队绩效与每个结果相关的其他结构变量之间的关联，控制疗养院入院时存在的个人风险因素。从这项研究中获得的信息尤其及时，因为人们对养老院护理质量的关注仍在继续，对养老院工作人员的配备和周转的担忧也在加剧。迄今为止，对护理质量与组织或劳动力因素之间关系的研究主要是轶事。从本研究中获得的经验见解可用于测试和评估工作场所创新和公共政策干预，旨在提高员工的保留率和满意度

DESCRIPTION (provided by applicant): The objective of the proposed study is to assess the performance of nursing home teams and to investigate the impact of team performance on patient care outcomes. Studies in settings outside of nursing homes have shown the existence of a strong relationship between team performance and risk-adjusted patient outcomes. If this relationship can be documented in nursing homes, there is a significant potential for improving the quality of patient care through identification and dissemination of information about model team practices. The conceptual model for the analyses rests on the quality paradigm proposed by Donabedian and a cause-and-effect model adapted from Shorten. The study will include a randomly selected sample of 375 nursing homes throughout New York State, with an anticipated 60 percent participation rate. Quality of care will be assessed with respect to three outcomes - functional status, pressure ulcers, and urinary incontinence. Team performance will be measured on six dimensions - leadership, communication, coordination, conflict management, team cohesion, and team effectiveness. Primary data will be obtained through surveys and interviews. Secondary data will include the minimum data set (MDS), the On-line Survey Certification and Reporting System (OSCAR), and the Area Resource File (ARF). Data analyses will include multivariate regression techniques to test specific hypotheses about team performance and the association between team performance and other structural variables with respect to each outcome, controlling for individual risk factors present at admission to nursing home. The information to be gained from this study is particularly timely, as concerns about quality of care in nursing homes continue and as apprehension about the staffing and turnover of nursing home workforce intensify. To date, research into the relationship between quality of care and organizational or workforce factors has been largely anecdotal. Empirical insights gained from this study may be used to test and evaluate workplace innovations and public policy interventions aimed at improving workforce retention and quality, thus improving the quality of patient care.