title: A systems framework for evaluating nursing care quality in nursing homes.
abstract: Given the ongoing concerns about the quality of care in nursing homes, a theoretical framework to guide a systems approach to quality is important. Existing frameworks either do not model causality, or do so in a linear fashion in which the actual linkages between components of quality may not be well specified. Through a review of frameworks for nursing home quality, and empirical studies on the subject, the authors construct a framework for nursing home quality that links contextual components of quality with structure, structure with process, and process with outcomes, focusing on nursing care quality. Intrastructural relationships and feedback mechanisms are also modeled. The framework is matched with a discussion of multilevel structural equation analysis for statistical application. Future research should expand the framework to include non-nursing components of quality.
authors.affiliation: Health Services Administration, Department of Health Professions, College of Health and Public Affairs, HPA-2, Room 210-L, University of Central Florida, Orlando, Florida 32816-2200, USA. lunruh@mail.ucf.edu
authors.forename: Lynn
authors.initials: L
authors.lastname: Unruh
authors.forename: Thomas T H
authors.initials: TT
authors.lastname: Wan
mesh_terms: D009732:Nursing Care / Q000592:standards*; D009735:Nursing Homes / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000458:organization & administration; D014481:United States