Can a survey influence quality of care in nursing homes? The impact of the New York Quality Assurance System on resident deterioration and adverse outcomes.
Data from a standardized administrative form, the Patient Review Instrument, were used to evaluate whether the New York Quality Assurance System (NYQAS) had an impact on deterioration in functional status or on the incidence of adverse outcomes among residents in New York's nursing homes. The NYQUAS approach evaluated nursing homes by using "triggers" suggestive of deficient quality of care. A random sample of nursing home facilities was selected from data encompassing 2 years before and 2 years after the implementation of NYQAS in 1988. Growth curve analysis and logistic regression were used to assess the influence of NYQAS on deterioration and on the probability of developing decubitus ulcers or contractures, or of being mechanically restrained. The functional status of most residents did not change significantly over time. After allowing statistically for differences in the resource needs of residents within the facilities, the implementation of NYQAS was associated with decreased deterioration in toileting and/or transferring, depending on the site of care. NYQAS was not associated with changes in incidence rates of decubitus, contractures, or the use of mechanical restraints.
Abt Associates, Inc.
C E
CE
Schwartz
R J
RJ
Ozminkowski
D C
DC
Hoaglin
M
M
Cella
L G
LG
Branch
D000203:Activities of Daily Living; D000367:Age Factors; D015897:Comorbidity; D005260:Female; D006304:Health Status; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009127:Muscle Rigidity / Q000453:epidemiology; D009518:New York / Q000453:epidemiology; D009735:Nursing Homes / Q000592:standards*; D003668:Pressure Ulcer / Q000453:epidemiology; D015397:Program Evaluation / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000592:standards*; D012149:Restraint, Physical; D012307:Risk Factors; D011795:Surveys and Questionnaires