Quality of care in nursing home organizations: establishing a health services research agenda.
Health services research has led to exciting new findings about the critical importance of the amount and type of nursing staff in nursing homes for improving the processes and outcomes of care. This paper reviews recent theoretical and research issues and outlines areas where research is needed. The nursing home research agenda for the future needs to concentrate on: (1) the relationship between structural measures of nursing (eg, staffing levels, education, turnover rates) and the outcomes and processes of care; (2) adequate processes of care and ways to improve the reliability of clinical outcome measures; (3) better ways to risk-adjust for resident characteristics; (4) the impact of nursing home characteristics (eg, ownership) and public policies (eg, reimbursement) on structural factors, processes, and outcomes; and (5) cost-effectiveness studies of nursing care at the organizational or system level.
Harrington
Charlene
C
Department of Social and Behavioral Sciences, University of California-San Francisco, 3333 California Street, Suite 455, San Francisco, CA 94118, USA. chas@itsa.ucsf.edu
D003362:Cost-Benefit Analysis; D003953:Diagnosis-Related Groups; D006291:Health Policy; D006301:Health Services Needs and Demand; D006302:Health Services Research / Q000458:organization & administration*; D006801:Humans; D019300:Medical Errors / Q000451:nursing / Q000517:prevention & control; D016294:Models, Nursing; D008962:Models, Theoretical; D015401:Nursing Administration Research / Q000458:organization & administration*; D009735:Nursing Homes / Q000592:standards*; D009739:Nursing Services / Q000458:organization & administration; D009740:Nursing Staff / Q000193:education / Q000458:organization & administration / Q000523:psychology; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D010563:Personnel Turnover; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000592:standards*; D012107:Research Design; D020379:Risk Adjustment; D017749:Total Quality Management / Q000458:organization & administration; D016526:Workload