Facility and area variation affecting the use of physical restraints in nursing homes.
OBJECTIVE
Various individual characteristics increase a nursing home resident's likelihood of being mechanically restrained. However, there is not good information on the role played by facility characteristics and geographic area in determining the likelihood of physical restraint use. This study investigates the importance of individual, facility, and area indicators in determining the likelihood of restraint use.


METHODS
This research uses data on 2,000 nursing home residents receiving care in more than 250 nursing homes in 10 different areas. Resident-level data were collected in 1990 by research nurses using the Minimum Data Set for Nursing Home Resident Assessment and Care Screening. Facility-level data were gathered by telephone interviews with facility staff. The relations among the variables were investigated using contingency tables and multivariate logistic regression models.


RESULTS
Controlling for residents' physical and cognitive function, facility characteristics and location had a significant impact on restraint practices. Those facilities with low nurse staffing were more likely to restrain residents. Furthermore, controlling for these factors, restraint practices varied significantly across the geographic areas in the study.


CONCLUSIONS
Like hospitals, nursing homes exhibit significant interfacility and regional variation in their clinical practices. Future analyses of nursing home care might benefit from considering both factors in much finer detail.
Phillips
C D
CD
Program on Aging, Research Triangle Institute, Research Triangle Park, NC, USA.
Hawes
C
C
Mor
V
V
Fries
B E
BE
Morris
J N
JN
Nennstiel
M E
ME
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D032763:Behavior Control; D002391:Catchment Area, Health; D003071:Cognition; D003625:Data Collection; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000145:classification / Q000706:statistics & numerical data*; D018579:Patient Selection; D040841:Resource Allocation; D012149:Restraint, Physical; D014481:United States