دورية أكاديمية
The Relationship between Nursing Home Staffing and Health Outcomes Revisited.
| العنوان: | The Relationship between Nursing Home Staffing and Health Outcomes Revisited. |
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| المؤلفون: | Mukamel DB; Department of Medicine, Division of General Internal Medicine, iTEQC Research Program, University of California, Irvine, CA, USA. Electronic address: dmukamel@hs.uci.edu., Saliba D; UCLA Borun Center at David Geffen School of Medicine, Los Angeles, CA, USA; Veterans Administration GRECC, Los Angeles, CA, USA; RAND Health, Santa Monica, CA, USA., Ladd H; Department of Medicine, Division of General Internal Medicine, iTEQC Research Program, University of California, Irvine, CA, USA., Konetzka RT; Department of Medicine, The University of Chicago, Chicago, IL, USA. |
| المصدر: | Journal of the American Medical Directors Association [J Am Med Dir Assoc] 2024 Aug; Vol. 25 (8), pp. 105081. Date of Electronic Publication: 2024 Jun 12. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: United States NLM ID: 100893243 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1538-9375 (Electronic) Linking ISSN: 15258610 NLM ISO Abbreviation: J Am Med Dir Assoc Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2005- : [New York?] : Elsevier Original Publication: Hagerstown, MD : Lippincott Williams & Wilkins, c2000- |
| مواضيع طبية MeSH: | Nursing Homes* , Personnel Staffing and Scheduling*/statistics & numerical data, Humans ; Retrospective Studies ; United States ; Quality of Health Care ; Outcome Assessment, Health Care ; Quality Indicators, Health Care ; Nursing Staff/supply & distribution |
| مستخلص: | Objective: Nursing homes make staffing decisions in conjunction with choosing quality goals, potentially leading to endogeneity bias between staffing and quality. We use instrumental variables (IVs) to explore it. Design: Retrospective statistical analysis of 2017-2019 Payroll-Based Journal, Minimum Data Set, Nursing Home Care Compare, and Long-Term Care Focus. Settings and Participants: A total of 11,261 nursing homes nationally. Methods: We estimated separate models for each of 6 quality measures as dependent variables, and registered nurses (RNs), certified nurse assistants (CNAs), and licensed practical nurses (LPNs) as independent variables, including other control variables associated with quality. The models were estimated using both ordinary least squares (OLS) and 2-stage least squares (2SLS) methods, the latter accounting for endogeneity. The IVs were defined as the average staffing of competing nursing homes in the same market as the index facility. Results: Estimated coefficients for the quality measures in the 2SLS models were up to 5 times larger than in the OLS models. The 2SLS estimates for antipsychotic medications use increased with higher RN staffing [0.279 (0.004 to 0.553)] and decreased with higher CNAs [-0.125 (-0.198 to -0.052)]. Hospitalizations decreased with more RNs [-1.328 (-1.673 to -0.983)] and LPN staffing [-0.483 (-0.755 to -0.211])] and increased with CNA [0.201 (0.109 to 0.293)] staffing. Emergency room visits decreased with higher RNs [-1.098 (-1.500 to -0.696)] and increased with CNAs [0.191 (0.084 to 0.298)]. Long-stay activities of daily living [-0.313 (-0.416 to -0.209)] and short-stay functioning [-0.481 (-0.598 to -0.364)] improved only with higher CNA staffing and pressure sores improved only with increased RN staffing [-0.436 (-0.836 to -0.035)]. Conclusions and Implications: Our findings demonstrate the importance of accounting for endogeneity in studies of staffing and quality. Endogeneity changes conclusions about significance, direction, and magnitude of the relationship between staffing and specific quality measures. These findings highlight the need to further study and understand the nuanced relationship between different staffing types and different health outcomes such as the difference between the relationship of RN and CNA hours per resident day to antipsychotic quality measures. Competing Interests: Disclosures The authors declare no conflicts of interest. Debra Saliba is an employee of the Veterans Administration. The views presented here do not represent those of the Department of Veterans Affairs. The sponsor had no role except for funding. This work was supported by National Institutes of Health Grant R01AG066742. (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: Methods; nursing homes; quality measures; quality of care; staffing |
| تواريخ الأحداث: | Date Created: 20240615 Date Completed: 20240728 Latest Revision: 20240728 |
| رمز التحديث: | 20240728 |
| DOI: | 10.1016/j.jamda.2024.105081 |
| PMID: | 38878798 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1538-9375 |
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| DOI: | 10.1016/j.jamda.2024.105081 |