NRHA 2013 Nursing Home Quality
1 like509 views
This study examines the relationship between nurse staffing levels and care quality in rural nursing homes, highlighting differences between hospital-based and freestanding facilities. Findings indicate that nurse staffing correlates with lower quality in many measures, and higher RN staffing levels are associated with fewer deficiencies, particularly in hospital-based settings. The study underscores variability in outcomes based on facility type and emphasizes the need for further research in rural contexts.
NRHA 2013 Nursing Home Quality
- 1. Nurse Staffing and Quality in Rural Nursing Homes Peiyin Hung, MSPH, Michelle Casey, MS, Ira Moscovice, PhD NRHA Annual Meeting | May 2013 Supported by the Office of Rural Health Policy, Health Resources and Services Administration, PHS Grant No. U1CRH03717
- 2. Motivation for Study • Rural and urban nursing homes are different • Hospital-based and freestanding nursing homes are different • Previous studies have mixed conclusions • Paucity of research with rural context
- 3. Study Objective • What is the relationship between nurse staffing levels and care quality in rural nursing homes?
- 4. Methods: Data • 2011 Nursing Home Compare Data – Staffing and facility characteristics – Quality indicators • Minimum Dataset – Resource Utilization Group Case Mix index for all residents admitted to a facility • 4,825 rural nursing homes in our sample – 485 hospital-based (10%) – 4,340 freestanding (90%)
- 5. Outcome Measures • Individual quality indicators • Composite quality indicators • Health / Complaint inspections
- 6. Outcome Measures I Individual Quality Indicators Long-stay Short-stay Pain Pain Pressure Sores Pressure sores Decline of Activities of Daily Living (ADL) Physical Restraints Catheter Mobility Urinary Tract Infections
- 7. Outcome Measures II and III Composite Quality Scores Average of long-stay measures (reporting 3 or more measures) Average of short-stay measures (reporting any measure) Health / Complaint Inspections Total deficiencies Total actual harms Total minimal or potentially-actual harms Weighted total harms
- 8. Statistical Methods • Multivariate, ordinary least-squares models – Long-stay and short-stay quality measures – Weighted total harms • Negative binomial-regression models – Health/complaint inspections
- 9. Methods: Explanatory Variables Primary Nurse Staffing Levels Nursing Home Structure Secondary / Other Facility Operational Characteristics Facility Structure Characteristics State Fixed Effects
- 10. Limitations • Cross-sectional study design limits the ability to draw causal conclusions on relationships between staffing and quality. • Lack of individual resident-level data.
- 11. 1.26 0.92 2.74 0.63 0.77 2.43 RN-levels LPN-levels CNA-levels Hospital-based Freestanding 95% standard error of the mean Nurse Hours per Resident Day
- 12. 95% standard error of the mean % of Long-Stay Residents with Outcome Measures 8.1 14.7 4.2 9.1 1.7 6.1 12.4 9.0 8.1 15.1 3.5 9.6 2.6 5.4 11.3 9.0 Long-stay composite scores ADL Decline Pain Pressure Sores Physical Restraints Catheter Mobility Decline Urinary Tract Infection Hospital-based Freestanding
- 13. 24.1 2.0 21.5 27.2 2.1 24.5 Total deficiencies Total actual harms Total minimal harms or potentially actual harms Hospital-based Freestanding 95% standard error of the mean Health / Complaint Inspections
- 14. Results: Quality Outcome Measures (Higher is better) RN-levels LPN-levels CNA-levels Hospital-Based (vs. Freestanding) Long-stay composite scores − −*** − −*** ADL Decline − −*** − + Pain −** −*** − Pressure Sores −* −** −* −** Physical Restraints + + +** Catheter −* −* + −*** Mobility Decline − −* − − Urinary Tract Infection − −*** − − Short-stay composite scores −*** −*** + −*** Pain −*** −*** + −** Pressure Sores − −** + −*** *p<0.05 **p<0.01 ***p<0.001
- 15. Results: Health/Complaint Inspections *p<0.05 **p<0.01 ***p<0.001 (Higher is worse) RN-levels LPN-levels CNA- levels Hospital-Based (vs. Freestanding) Total deficiencies −*** −*** − +* Total actual harms −*** −*** + +* Total minimal harms or potentially actual harms −*** + −* +* Weighted total harms −*** −*** − +*
- 16. How Stratified Results Differ • In hospital-based nursing homes: – One unit RN-level is correlated with 3% less ADL decline prevalence rate and 4.7 fewer deficiencies. – RN-levels show no associations with other outcome measures.
- 17. How Stratified Results Differ • In freestanding nursing homes: – RN-levels and LPN-levels are correlated with lower quality outcome scores. – More CNA-levels are correlated with less pressure sores. – One unit increase of RN-levels is associated with 4 fewer deficiencies.
- 18. Summary • Relationships between staffing and quality in rural nursing homes vary by hospital-affiliation and quality measures. • Nurse staffing in rural nursing homes correlates with lower quality in many measures.
- 19. Summary (cont.) • Nurse staffing levels were associated with fewer deficiencies in both rural hospital-based and freestanding nursing homes. • RN-staffing levels in rural hospital-based facilities had stronger relationships with quality than in freestanding facilities.