Team Performance and Quality of Care in Nursing Homes

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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.