Staffing Characteristics of Nursing Homes and Quality

描述(由申请人提供)：考虑到在许多这样的设施中看到的几乎不妥协的低质量，从检查疗养院劳动力因素的影响中可能学到很多东西。虽然过去在这一领域的研究考察了人员更替和人员配置水平对质量的影响，但很少有研究考察多种劳动力因素的影响，或者考察劳动力的不同特征是否相互作用，以产生良好或不良的质量。因此，先前未指定的模型可能在一定程度上限制了我们对哪些劳动力因素对护理质量影响最大(最小)的理解。此外，只有微弱的证据表明工作人员比例影响护理质量，这也可能是由于大多数调查的性质不够具体所致。 在这项研究中，我们建议检验多重人员特征的影响，特别是 在大样本养老院中，人员流失率、人员配备水平、工人稳定性和机构工作人员对护理质量有影响。我们认为，养老院居民的护理需求越来越复杂，设施正在使用越来越复杂的技术。关心不仅取决于做了多少，而且取决于做了什么，做得有多好，什么时候做了，由谁做了。因此，仅仅增加更多的工作人员可能是提高质量的必要手段，但不是充分手段。更充分地审查护理过程是重要的，可能会导致关于人员配备问题的更广泛的政策辩论，而不是养老院的人员配备水平。 在初步分析中，我们已确定人员配备水平、人员更替、稳定性和机构工作人员的使用对质量有重要影响。在这个项目中，我们建议通过使用更大的样本、更精细的质量衡量标准和更具体的人员配置特征变量来扩展这一先前的研究。我们将把从2,946家养老院营业额的独特调查中收集的数据与来自最小数据集(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。人员配置特征将来自原始数据，居民特征和质量指标将来自MDS，设施特征将来自OSCAR，市场特征将来自ARF。我们将不仅对执业护士(LPN)和注册护士(RN)，而且对护士助理(NAS)，研究人员配备水平、人员更替、稳定性、机构员工使用和质量之间的联系。

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 as examined the effect of turnover and staffing levels on quality, there have been very few studies that have examined the impact of multiple workforce factors or that have looked at whether different characteristics of the workforce interact to produce either good or bad quality. Thus, prior underspecified models may have served to limit somewhat our understanding of which workforce factors influence most (least) quality of care. In addition, only weak evidence exists that staff ratios influence quality of care, again probably due to the underspecified nature of most investigations. In this research, we propose to examine the influence that multiple staffing characteristics, specifically turnover, staffing levels, worker stability, and agency staff, has 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 care processes more adequately is important, and may lead to broader policy debate over staffing issues rather than staffing levels in nursing homes. In preliminary analyses, we have identified staffing levels, turnover, stability, and use of agency staff as significant influences 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 2,946 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 staffing levels, turnover, stability, and use of agency staff and quality, not only for licensed practical nurses (LPNs), and registered nurses (RNs), but also for nurse aides (NAs).