The Influence of Staff Turnover on Quality

描述（由申请人提供）：工作人员流动影响质量的信念是普遍存在的。事实上，养老院的员工流动率经常被用作质量指标。然而，根据文献中的实证研究，这可能为时过早，因为营业额和质量之间的关联一般是不确定的。在这一领域的一些进一步研究显然是必要的。对其他行业人员流动情况的研究结果也表明，一些人员流动是有益的，而较高的人员流动水平会对业绩产生负面影响。显然，如果营业额确实根据所观察到的水平在不同方向上影响质量，那么通过使用营业额的一个线性度量，这种影响可能会被掩盖。在这方面的一些进一步的研究在养老院也显然是必要的。在这项倡议中，我们建议使用以前从2,127个护理设施收集的数据，并检查员工流动率和质量之间的关联。在职劳动力主要由护士助理（NAs）组成，他们提供80%至90%的居民护理，但也包括执业护士（LPNs）和注册护士（RNs）。这些是我们要检查的员工。工作人员流动的信息收集的一部分，正在进行的研究调查营业额报告的准确性由疗养院。我们建议使用五个公认的护理质量指标在养老院。这些是身体约束使用率，导尿术，压疮，精神药物使用率和持续疼痛率。我们认为：（1）检查不同水平的营业额;（2）使用我们精确的营业额测量方法;（3）使用最小数据集（MDS）关于质量和病例组合的居民水平数据-这项拟议的研究比以前的工作有了很大的改进。因此，使用先前收集的主要数据与次要数据源（如MDS）相匹配，我们建议检查：（1）照顾者更替与护理人员更替之间的关联（RNs，LPNs，and NAs）和质量指标;（2）不同照顾者的贡献（RN、LPN和NA）与营业额和质量指标之间的关联;（3）一定程度的人员流动是否与质量指标正相关，以及在什么程度上人员流动与质量指标负相关。

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.