title: Nursing homes with persistent deficiency citations for physical restraint use.
abstract: OBJECTIVE
  This paper examines the organizational and aggregate resident characteristics of nursing homes associated with persistent poor quality in the use of physical restraints. Deficiency citations for physical restraint use in two and three consecutive certification survey inspections are used as our measures of poor quality.
  
  
  METHODS
  Nationally representative data from the 1996, 1997, 1998, and 1999 Online Survey, Certification, and Reporting system are used, first, to provide descriptive analyses. Second, multinomial logistic regression analyses are used to examine organizational and aggregate resident characteristics associated with deficiency citations for restraint use on any survey inspection, on two consecutive inspections, and deficiencies for physical restraint use in three consecutive inspections.
  
  
  RESULTS
  It is shown that 729 (5.2%) nursing homes had deficiency citations for restraint use on two consecutive inspections and 317 (2.3%) on three consecutive inspections. Persistent poor quality in the use of physical restraints in nursing homes is negatively associated to higher staffing levels of care givers, and positively associated to higher Medicaid census, and higher average activities of daily living (ADL) levels.
  
  
  CONCLUSIONS
  The Nursing Home Reform Act has been extremely influential in reducing the overall prevalence of physical restraint use in nursing homes, but the number of facilities with persistent quality problems in their use of restraints in the face of this legislation is surprising. The organizational and aggregate resident characteristics of these nursing homes, especially RN staffing levels, Medicaid census, and average ADL levels differ from those that did not receive any deficiency citations for use of physical restraints.
authors.affiliation: RAND, Pittsburgh, Pennsylvania 15213, USA. NICK_CASTLE@RAND.org
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Castle
mesh_terms: D000203:Activities of Daily Living; D002568:Certification; D016001:Confidence Intervals; D006302:Health Services Research; D006801:Humans; D008484:Medicaid; D009728:Nursing Assistants / Q000600:supply & distribution; D009735:Nursing Homes / Q000331:legislation & jurisprudence / Q000592:standards*; D009740:Nursing Staff / Q000600:supply & distribution; D010561:Personnel Staffing and Scheduling; D011785:Quality Assurance, Health Care / Q000331:legislation & jurisprudence*; D019984:Quality Indicators, Health Care; D012044:Regression Analysis; D012149:Restraint, Physical / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D014481:United States