title: Pressure ulcer development in the VA: characteristics of nursing homes providing best care.
abstract: This study identifies structural characteristics of VA nursing homes that are associated with the best patient outcomes. We evaluated risk-adjusted rates of pressure ulcer development in VA nursing homes and related these rates to facility size, staffing patterns, teaching nursing home status, and rural versus urban locale. Higher rates of pressure ulcer development were seen among urban teaching nursing homes and among nursing homes associated with both larger and smaller VA hospitals. Staffing patterns had a complex association with pressure ulcer development, and smaller nursing home staffs were not clearly associated with higher rates. For multivariate modeling, only hospital size and staffing remained significant independent predictors of pressure ulcer development. These results emphasize that while structural characteristics of VA nursing homes can provide insights about care, improving the quality of care in this setting will require a much greater understanding of how nursing homes are organized to meet patient needs.
authors.affiliation: Center for Health Quality, Outcomes, and Economic Research, Bedford VA Hospital, MA 01730, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Berlowitz
authors.forename: J J
authors.initials: JJ
authors.lastname: Anderson
authors.forename: G H
authors.initials: GH
authors.lastname: Brandeis
authors.forename: L A
authors.initials: LA
authors.lastname: Lehner
authors.forename: H K
authors.initials: HK
authors.lastname: Brand
authors.forename: A S
authors.initials: AS
authors.lastname: Ash
authors.forename: M A
authors.initials: MA
authors.lastname: Moskowitz
mesh_terms: D000368:Aged; D019985:Benchmarking; D006707:Homes for the Aged / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D016014:Linear Models; D015999:Multivariate Analysis; D009735:Nursing Homes / Q000458:organization & administration / Q000592:standards*; D017063:Outcome Assessment, Health Care; D003668:Pressure Ulcer / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs