The Influence of Staff Turnover on Quality

描述(由申请者提供)：普遍认为员工的流动会影响质量。事实上，养老院的员工流动率经常被用作质量指标。然而，基于文献中的实证研究，这可能为时过早，因为营业额和质量之间的联系通常是不确定的。这一领域的一些进一步研究显然是有必要的。其他行业的离职率研究结果也表明，一些员工的离职率是有益的，而较高的离职率会对业绩产生负面影响。显然，如果营业额确实根据观察到的水平在不同的方向上影响质量，那么通过使用营业额的一个线性衡量标准，这种影响可能会被掩盖。养老院在这一领域的一些进一步研究也显然是有必要的。在这项倡议中，我们建议使用之前从2,127家护理机构收集的数据，并检查员工流动率和质量之间的关联。护理劳动力主要由提供80%至90%住院护理的护士助理(NAS)组成，但也包括有执照的执业护士(LPN)和注册护士(RN)。这些是我们要检查的员工。这些关于员工流动率的信息是作为正在进行的一项研究的一部分收集的，该研究调查了养老院人员流失率报告的准确性。我们建议在疗养院使用五个被广泛接受的护理质量指标。这些是身体束缚使用、导尿术、压疮、精神活性药物使用和持续性疼痛的比率。我们认为，通过：(1)检查不同的人员更替水平；(2)使用我们对人员更替的精确测量；以及(3)使用关于质量和病例组合的最小数据集(MDS)驻地水平数据--这项拟议的研究比以前的工作有了相当大的改进。因此，使用先前收集的与辅助数据源(如MDS)匹配的原始数据，我们建议检查：(1)护理者周转(RN、LPN和NAS)与养老院质量指标之间的关联；(2)不同护理者(RN、LPN和NAS)对周转与质量指标之间的关联的贡献；(3)某种程度的周转是否与质量指标正相关，以及在什么情况下，周转与质量指标负相关。

DESCRIPTION (provided by applicant): The belief that staff turnover influences quality is pervasive. Indeed, staff turnover in nursing homes is often used as a quality indicator. However, based on empirical studies in the literature this may be premature, as the association between turnover and quality is generally inconclusive. Some further research in this area is clearly warranted. Results from turnover studies set in other industries have also shown that some staff turnover is beneficial, and it is higher levels of turnover that negatively influence performance. Clearly, if turnover does influence quality in different directions depending on the level observed, then by using one linear measure of turnover the effects may be masked. Some further research in this area in nursing homes is also clearly warranted. In this initiative, we propose to use data previously collected from 2,127 nursing facilities and examine the association between staff turnover and quality. The caregiving labor force consists primarily of nurse aides (NAs) who provide 80 to 90% of resident care, but also includes licensed practical nurses (LPNs), and registered nurses (RNs). These are the staff we examine. The information on staff turnover was collected as part of an ongoing study investigating the accuracy of turnover reporting by nursing homes. We propose to use five well-accepted indicators of care quality in nursing homes. These are the rates of physical restraint use, urethral catheterization, pressure ulcers, psychoactive medication use, and persistent pain. We believe that by: (1) examining different levels of turnover; (2) using our precise measure of turnover; and (3) using the Minimum Data Set (MDS) resident-level data on quality and case mix - this proposed study represents a considerable improvement over prior works. Thus, using previously collected primary data matched to secondary data sources, such as the MDS, we propose to examine: (1) Association between caregiver turnover (RNs, LPNs, and NAs) and quality indicators in nursing homes; (2) Contribution of different caregivers (RNs, LPNs, and NAs) to the association between turnover and quality indicators; (3) Whether some level of turnover is positively associated with quality indicators and at what point turnover is negatively associated with quality indicators.