Systematic review of studies of staffing and quality in nursing homes.
OBJECTIVE
To evaluate a range of staffing measures and data sources for long-term use in public reporting of staffing as a quality measure in nursing homes.


METHODS
Eighty-seven research articles and government documents published from 1975 to 2003 were reviewed and summarized. Relevant content was extracted and organized around 3 themes: staffing measures, quality measures, and risk adjustment variables. Data sources for staffing information were also identified.


RESULTS
There is a proven association between higher total staffing levels (especially licensed staff) and improved quality of care. Studies also indicate a significant relationship between high turnover and poor resident outcomes. Functional ability, pressure ulcers, and weight loss are the most sensitive quality indicators linked to staffing. The best national data sources for staffing and quality include the Minimum Data Set (MDS) and On-line Survey and Certification Automated Records (OSCAR). However, the accuracy of this self-reported information requires further reliability and validity testing.


CONCLUSIONS
A nationwide instrument needs to be developed to accurately measure staff turnover. Large-scale studies using payroll data to measure staff retention and its impact on resident outcomes are recommended. Future research should use the most nurse-sensitive quality indicators such as pressure ulcers, functional status, and weight loss.
Bostick
Jane E
JE
University of Missouri-Columbia, Columbia, MO 65211, USA. bostickj@missouri.edu
Rantz
Marilyn J
MJ
Flesner
Marcia K
MK
Riggs
C Jo
CJ
D000203:Activities of Daily Living; D000368:Aged; D003625:Data Collection / Q000379:methods* / Q000592:standards; D003953:Diagnosis-Related Groups / Q000458:organization & administration; D015577:Geriatric Assessment; D006302:Health Services Research; D006801:Humans; D015401:Nursing Administration Research; D009728:Nursing Assistants / Q000600:supply & distribution; D009735:Nursing Homes / Q000458:organization & administration*; D009740:Nursing Staff / Q000600:supply & distribution; D009743:Nursing, Practical; D017063:Outcome Assessment, Health Care / Q000458:organization & administration; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D003668:Pressure Ulcer / Q000453:epidemiology / Q000517:prevention & control; D019984:Quality Indicators, Health Care / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration*; D015203:Reproducibility of Results; D012107:Research Design; D020379:Risk Adjustment / Q000458:organization & administration; D012680:Sensitivity and Specificity; D014481:United States; D015431:Weight Loss; D000078329:Workforce