Agency Staffing and Nursing Home Quality

描述（由申请人提供）：考虑到许多养老院几乎不妥协的低质量，从检查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考察了人员流动和人员配备水平对质量的影响，但还没有研究考察机构人员配备的影响。在这项研究中，我们建议在一个大样本的养老院检验机构人员配置特征对护理质量的影响。我们认为，养老院的居民有越来越复杂的护理需求，设施也在使用越来越复杂的技术。关心不仅取决于做了多少，还取决于做了什么，做得怎么样，什么时候做，由谁做。因此，简单地增加工作人员可能是提高质量的必要但不充分的手段。审查机构人员配备可能会导致更广泛的关于人员配备问题的政策辩论，而不是养老院的人员配备水平。在初步分析中，我们确定使用机构工作人员对质量有重大影响。在这个项目中，我们建议通过使用更大的样本、更精细的质量度量和更好地指定人员配置特征变量来扩展先前的研究。我们将把从6005家养老院的营业额调查中收集的数据与最小数据集（MDS）、在线调查认证和记录（OSCAR）系统和区域研究文件（ARF）的数据合并。人员特征来自原始数据，居民特征和质量指标来自MDS，设施特征来自OSCAR，市场特征来自ARF。我们将研究机构人员的使用与质量之间的关系，不仅针对执业护士（lpn）和注册护士（rn），还包括护理助理（NAs）。

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.