Nurse Staffing & Nursing Care Quality in Nursing Homes

描述(由申请人提供)：2000年，全国21%的护理机构因一般护理质量缺陷而被引用，13%被引用为居民评估不佳，17%被引用为未能提供全面的护理计划。护理人员配备对养老院护理服务的提供有重要影响。尽管如此，护士的人员配置水平在过去几年里各不相同，特别是在平衡预算法案下。目前尚不清楚这些人员变动可能如何影响养老院的护理质量。本研究的目的是：1)使用管理和评估数据评估护理质量结构的有效性和可靠性；2)用制度框架检验护理质量的差异或变化；3)识别护士人员配备和护理充分性对护理质量的影响，控制制度(背景和市场)因素的影响；4)评估平衡预算法案对养老院实践和质量的影响；5)对高绩效养老院进行标杆和概况分析；6)多层次分析背景或制度因素对护理人员配备、护理充分性和养老院护理质量的影响；7)使用养老院管理数据(OSCAR)和最小数据集(MDS)住院评估数据，确定护理质量指标的同时效度。 这项研究将使用一个行政数据集--在线调查、认证和报告(OSCAR)--从1997-2004年间由14,000个机构组成的小组汇编而成。这些面板数据将与区域资源文件合并，以获取与养老院设施分布相关的背景和市场特征。将使用多元统计建模技术来分析现有的八波奥斯卡数据和四年的MDS数据：养老院护理质量的验证性因素分析(目标1)、护理质量制度决定因素的协方差结构建模(目标2)、护士人员配置对护理质量的中介作用的多水平分析(目标3)、护士人员配置和质量变化的增长曲线建模(目标4)、高质量设施的基准分析(目标5)、护理质量结构-过程-结果的背景效应的多水平协方差分析和增长曲线建模(目标6)，并通过验证性因素分析同时验证OSCAR和MDS质量指标(Aim7)。我们的建议侧重于护理机构护士人员配置和质量轨迹的重要预测因素。我们的发现将证明护士人员配置的重要性，并推动制定操作策略，以改善疗养院质量的结构和过程方面。

DESCRIPTION (provided by applicant): In 2000 21% of nursing facilities nationally were cited for general quality of care deficiencies, 13% for poor resident assessment, and 17% for failure to provide a comprehensive care plan. Nurse staffing has an important influence on the delivery of nursing home care. Nonetheless, nurse-staffing levels varied over the past years, particularly under the Balanced Budget Act. It is unclear how those staff changes may have affected nursing homes' quality of care. The purposes of this study are to 1) assess the validity and reliability of the construct of nursing care quality, using administrative and assessment data; 2) examine differences or variations in nursing care quality with an institutional framework; 3) identify the effect of nurse staffing and nursing care adequacy on nursing care quality, controlling the effects of institutional (contextual and market) factors; 4) evaluate the impact of the Balanced Budget Act on nursing home practice and quality; 5) perform benchmarking and profile analysis of high-performance nursing homes, 6) perform multilevel analysis of the effects of contextual or institutional factors on nurse staffing, nursing care adequacy and nursing care quality of nursing homes;7) determine the concurrent validity of nursing care quality indicators, using nursing homes' administrative data (OSCAR) and Minimum Data Set (MDS) resident assessment data. The study will use an administrative dataset--the Online Survey, Certification, and Reporting (OSCAR)_compiled from a panel of 14,000 facilities in 1997-2004. These panel data will be merged with the Area Resource File to capture the contextual and market characteristics associated with the distribution of nursing home facilities. Multivariate statistical modeling techniques will be used to analyze the eight waves of OSCAR data and four years of MDS data to be available: confirmatory factor analysis of nursing care quality in nursing homes (Aim 1), covariance structure modeling of institutional determinants of nursing care quality (Aim 2), multilevel analysis of the mediating effect of nurse staffing on nursing care quality (Aim 3), growth curve modeling of changes in nurse staffing and in quality (Aim 4), benchmarking analysis of high-quality facilities (Aim 5), multilevel covariance analysis and growth curve modeling of contextual effects on the structure-process-outcome of nursing care quality (Aim 6), and concurrent validation with OSCAR and MDS quality indicators by confirmatory factor analysis (Aim7). Our proposal focuses on important predictors of the trajectories of nursing facilities' nurse staffing and quality. Our findings will demonstrate the importance of nurse staffing and drive the development of operational strategies to improve the structural and process aspects of nursing home quality.