title: Direct observations of nursing home care quality: Does care change when observed?
abstract: OBJECTIVE
  Recent research demonstrates that care recorded by nursing home (NH) staff is often inaccurate. Direct observations of care may therefore be of critical importance in assessing and improving care in this setting. Unfortunately, despite their apparent use in several types of quality assurance activities, there is little written information about the reliability or accuracy of observational procedures in NHs. This paper provides information about one important measurement issue (reactivity) that is often cited as a limitation of observational procedures in measuring usual care practices accurately.
  
  
  METHODS
  Descriptive.
  
  
  METHODS
  Seven nursing homes.
  
  
  METHODS
  Staff and residents.
  
  
  METHODS
  Direct observational time in bed; repositioning and feeding assistance.
  
  
  RESULTS
  Observational measures of care quality were stable over multiple observation periods and consistently detected quality problems even on the first and last days of observation.
  
  
  CONCLUSIONS
  Direct observations of care provided to residents do not appear to change provider behavior.
authors.affiliation: Geriatric Research Education and Clinical Center, VA Greater Los Angeles Health Care System, Los Angeles, CA, USA. JSchnell@ucla.edu
authors.forename: John F
authors.initials: JF
authors.lastname: Schnelle
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Ouslander
authors.forename: Sandra F
authors.initials: SF
authors.lastname: Simmons
mesh_terms: D001291:Attitude of Health Personnel; D001510:Bed Rest / Q000451:nursing / Q000592:standards; D001519:Behavior; D015982:Bias; D002985:Clinical Protocols; D003625:Data Collection / Q000379:methods / Q000592:standards*; D015987:Effect Modifier, Epidemiologic; D006302:Health Services Research / Q000379:methods / Q000592:standards*; D006801:Humans; D008485:Medical Audit / Q000379:methods / Q000592:standards; D009728:Nursing Assistants / Q000523:psychology / Q000592:standards; D009735:Nursing Homes / Q000592:standards; D009740:Nursing Staff / Q000523:psychology / Q000592:standards; D018529:Nutritional Support / Q000451:nursing / Q000592:standards; D019370:Observation / Q000379:methods; D011187:Posture; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care / Q000592:standards; D013997:Time Factors; D017749:Total Quality Management