Physician and nurse staffing in nursing homes: the role and limitations of the Online Survey Certification and Reporting (OSCAR) system.
OBJECTIVE
To assess nursing home staffing data reported in the Online Survey Certification and Reporting (OSCAR) system database for research and policy.


METHODS
Comparisons were made between OSCAR and a concurrent research survey of staffing data collected for the same facilities, using inter-rater agreement and correlation analyses.


METHODS
Freestanding nursing homes from New York State (NYS) in 1997 (N = 327).


METHODS
Selected staffing variables were defined in comparable terms in both OSCAR and the NYS survey.


RESULTS
The two data sources were in substantial agreement on the reported availability of a full-time physician (other than medical director) and of a physician assistant or nurse practitioner (Kappa >0.7), and they correlated well in the full-time equivalent (FTE) number of such staff (Spearman correlation >0.6). The correlation was 0.8 for FTE registered nurses (RNs), 0.7 for licensed practical nurses (LPNs), and 0.8 for certified nurse aides (CNAs). In terms of average nurse hours per patient day, separately for RNs, LPNs, CNAs, and all combined, the correlation was relatively weak (between 0.3 and 0.6). Overall staffing levels tended to be lower in OSCAR than in NYS.


CONCLUSIONS
The OSCAR data are useful for exploring relationships between staffing and various quality of care outcomes, but may not be accurate enough on a case-specific basis, or to determine policy regarding minimal staffing levels using average nurse hours per patient day measures. More systematic and timely efforts are needed to refine the OSCAR content and survey methodology to document nursing home staffing information.
Feng
Zhanlian
Z
Center for Gerontology and Health Care Research, Brown University, Providence, RI 02912, USA. Zhanlian_Feng@Brown.edu
Katz
Paul R
PR
Intrator
Orna
O
Karuza
Jurgis
J
Mor
Vincent
V
D014487:Centers for Medicare and Medicaid Services, U.S.; D016208:Databases, Factual / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D008503:Medical Staff / Q000600:supply & distribution*; D009518:New York; D009735:Nursing Homes; D009740:Nursing Staff / Q000600:supply & distribution*; D015588:Observer Variation; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data*; D010562:Personnel Staffing and Scheduling Information Systems / Q000706:statistics & numerical data*; D018709:Statistics, Nonparametric; D014481:United States; D000078329:Workforce