Agency Staffing and Nursing Home Quality

描述（由申请人提供）：考虑到在许多这些设施中看到的几乎不妥协的低质量，从研究养老院劳动力因素的影响中可以学到很多东西。虽然过去在这一领域的研究已经审查了更替和人员配置水平对质量的影响，但还没有研究审查机构人员配置的影响。在这项研究中，我们建议研究机构的人员配置特点对护理质量的影响，在一个大样本的养老院。我们认为，养老院居民有越来越复杂的护理需求，设施正在使用越来越复杂的技术。护理不仅取决于做了多少，而且还取决于做了什么，做得多好，什么时候做，由谁做。因此，增加人手可能是改善质素的必要方法，但并不足够。审查机构的人员配置可能会导致更广泛的政策辩论的人员配置问题，而不是在养老院的人员配置水平。在初步分析中，我们已经确定使用机构工作人员对质量有重大影响。在这个项目中，我们建议扩展这一先前的研究，通过使用更大的样本，更精细的质量措施，更好地指定的员工特征变量。我们将合并从6,005家养老院的营业额调查中收集的数据，这些数据来自：最小数据集（MDS），在线调查认证和记录（OSCAR）系统和区域研究文件（ARF）。人员特征将来自原始数据，居民特征和质量指标将来自MDS，设施特征将来自OSCAR，市场特征将来自ARF。我们将研究机构工作人员的使用和质量之间的关联，不仅为执业护士（LPNs），注册护士（RNs），而且为护士助理（NAs）。 公共卫生相关性：高更替率和缺勤率，加上维持最低工作人员水平的监管压力，导致更多地使用机构工作人员来满足养老院的人员需求。然而，人们对这种新兴的做法及其对护理质量的影响知之甚少。这项调查审查了机构工作人员的使用和护理质量。我们的研究结果将对政策制定者、从业者和消费者产生影响。

DESCRIPTION (provided by the applicant): It is possible that much can be learned from examining the effect of workforce factors in nursing homes, given the almost intransigent low quality seen in many of these facilities. Although past research in this area has examined the effect of turnover and staffing levels on quality, there have been no studies that have examined the impact of agency staffing. In this research, we propose to examine the influence that agency staffing characteristics have on quality of care in a large sample of nursing homes. We believe that nursing home residents have increasingly more complex care needs, and facilities are using increasingly complex technology. Care is also dependent not only on how much is done, but upon what is done, how well it is done, when it is done, and by whom. Thus, simply adding more staff may be a necessary but not sufficient means of improving quality. Examining agency staffing may lead to broader policy debate over staffing issues rather than staffing levels in nursing homes. In preliminary analyses, we have identified use of agency staff as a significant influence on quality. In this project, we propose to extend this prior research, by using a larger sample, more refined measures of quality, and better specified staffing characteristic variables. We will merge data collected from a unique survey on turnover from 6,005 nursing homes with data from: the Minimum Data Set (MDS), the On-line Survey Certification and Recording (OSCAR) system, and the Area Research File (ARF). Staffing characteristics will come from the primary data, resident characteristics and quality indicators will come from the MDS, facility characteristics will come from the OSCAR, and market characteristics will come from the ARF. We will examine the associations between use of agency staff and quality, not only for licensed practical nurses (LPNs), and registered nurses (RNs), but also for nurse aides (NAs). PUBLIC HEALTH RELEVANCE: High turnover and absenteeism, combined with regulatory pressure to maintain minimum staff levels, has led to an increase in use of agency staff to cover staffing needs in nursing homes. Yet, little is known about this emerging practice and its impact on quality of care. This investigation examines use of agency staff and quality of care. Our results will have implications for policy makers, practitioners, and consumers.