title: Nursing home work environment and the risk of pressure ulcers and incontinence.
abstract: OBJECTIVE
  To examine the association between nursing home (NH) work environment attributes such as teams, consistent assignment and staff cohesion, and the risk of pressure ulcers and incontinence.
  
  
  METHODS
  Minimum dataset for 46,044 residents in 162 facilities in New York State, for June 2006-July 2007, and survey responses from 7,418 workers in the same facilities.
  
  
  METHODS
  For each individual and facility, primary and secondary data were linked. Random effects logistic models were used to develop/validate outcome measures. Generalized estimating equation models with robust standard errors and probability weights were employed to examine the association between outcomes and work environment attributes. Key independent variables were staff cohesion, percent staff in daily care teams, and percent staff with consistent assignment. Other facility factors were also included.
  
  
  RESULTS
  Residents in facilities with worse staff cohesion had significantly greater odds of pressure ulcers and incontinence, compared with residents in facilities with better cohesion scores. Residents in facilities with greater penetration of self-managed teams had lower risk of pressure ulcers, but not of incontinence. Prevalence of consistent assignment was not significantly associated with the outcome measures.
  
  
  CONCLUSIONS
  NH environments and management practices influence residents' health outcomes. These findings provide important lessons for administrators and regulators interested in promoting NH quality improvement.
authors.affiliation: Department of Community and Preventive Medicine, University of Rochester School of Medicine, Rochester, NY 14642, USA. Helena_Temkin-Greener@urmc.rochester.edu
authors.forename: Helena
authors.initials: H
authors.lastname: Temkin-Greener
authors.forename: Shubing
authors.initials: S
authors.lastname: Cai
authors.forename: Nan Tracy
authors.initials: NT
authors.lastname: Zheng
authors.forename: Hongwei
authors.initials: H
authors.lastname: Zhao
authors.forename: Dana B
authors.initials: DB
authors.lastname: Mukamel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005242:Fecal Incontinence / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006707:Homes for the Aged / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D007400:Interprofessional Relations; D016015:Logistic Models; D008297:Male; D009518:New York / Q000453:epidemiology; D009735:Nursing Homes / Q000458:organization & administration* / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000458:organization & administration; D010559:Personnel Management; D003668:Pressure Ulcer / Q000453:epidemiology / Q000517:prevention & control*; D015995:Prevalence; D011787:Quality of Health Care; D020379:Risk Adjustment; D014549:Urinary Incontinence / Q000453:epidemiology / Q000517:prevention & control*; D017132:Workplace
references.citation: J Am Med Dir Assoc. 2007 May;8(4):253-61
references.pmid: 17498610
references.citation: Gerontologist. 1998 Jun;38(3):370-8
references.pmid: 9640857
references.citation: J Am Med Dir Assoc. 2006 Jan;7(1):46-59
references.pmid: 16413435
references.citation: Age Ageing. 2003 Jan;32(1):12-8
references.pmid: 12540342
references.citation: Med Care. 2004 May;42(5):472-81
references.pmid: 15083108
references.citation: Am J Med Qual. 1999 Jan-Feb;14(1):39-44
references.pmid: 10446662
references.citation: Health Care Manage Rev. 1999 Winter;24(1):7-16
references.pmid: 10047975
references.citation: Gerontologist. 2004 Jun;44(3):368-77
references.pmid: 15197291
references.citation: Health Serv Res. 2008 Aug;43(4):1244-62
references.pmid: 18248401
references.citation: J Adv Nurs. 2007 May;58(3):263-72
references.pmid: 17474915
references.citation: Health Serv Res. 2003 Feb;38(1 Pt 1):65-83
references.pmid: 12650381
references.citation: Nurs Res. 2003 Jan-Feb;52(1):12-21
references.pmid: 12552171
references.citation: Gerontologist. 1998 Dec;38(6):665-83
references.pmid: 9868847
references.citation: Med Care. 2003 Apr;41(4):467-78
references.pmid: 12665711
references.citation: Gerontologist. 2007 Jun;47(3):323-39
references.pmid: 17565096
references.citation: Gerontologist. 2006 Feb;46(1):128-33
references.pmid: 16452293
references.citation: J Nurs Manag. 2010 Nov;18(8):1060-72
references.pmid: 21073577
references.citation: J Healthc Qual. 2005 Nov-Dec;27(6):6-14, 21, 44
references.pmid: 17514852
references.citation: Adv Skin Wound Care. 2001 Sep-Oct;14(5):244, 245-8
references.pmid: 11905972
references.citation: J Am Geriatr Soc. 2001 Jul;49(7):866-71
references.pmid: 11527476
references.citation: Gerontologist. 2008 Apr;48(2):142-8
references.pmid: 18483426
references.citation: Gerontologist. 2010 Jun;50(3):327-39
references.pmid: 20008040
references.citation: J Am Geriatr Soc. 2005 Oct;53(10):1721-9
references.pmid: 16181171
references.citation: Gerontologist. 2009 Dec;49(6):793-802
references.pmid: 19491363
references.citation: Health Serv Res. 1998 Jun;33(2 Pt Ii):354-80
references.pmid: 9618675
references.citation: J Am Med Dir Assoc. 2009 Jan;10(1):4-10
references.pmid: 19111847
references.citation: Med Care Rev. 1991 Summer;48(2):129-66
references.pmid: 10112152
references.citation: J Wound Ostomy Continence Nurs. 2006 Nov-Dec;33(6):610-8
references.pmid: 17108770
references.citation: Med Care. 2009 Apr;47(4):482-91
references.pmid: 19330892
references.citation: Gerontologist. 2003 Apr;43 Spec No 2:37-46
references.pmid: 12711723
references.citation: Urol Nurs. 2008 Dec;28(6):439-44, 453
references.pmid: 19241782
references.citation: Health Serv Res. 2009 Aug;44(4):1309-25
references.pmid: 19486181
references.citation: Annu Rev Public Health. 2008;29:369-82
references.pmid: 18173385
references.citation: J Am Geriatr Soc. 1990 Mar;38(3):356-60
references.pmid: 2313014
references.citation: Gerontologist. 1996 Aug;36(4):512-7
references.pmid: 8771979
references.citation: Gerontologist. 2004 Apr;44(2):256-61
references.pmid: 15075422
references.citation: J Gerontol A Biol Sci Med Sci. 2002 Jul;57(7):M422-7
references.pmid: 12084803
references.citation: Gerontologist. 2004 Feb;44(1):24-38
references.pmid: 14978318
references.citation: Gerontologist. 2005 Jun;45(3):309-17
references.pmid: 15933271
references.citation: Med Care. 2004 Nov;42(11):1037-9
references.pmid: 15586829
references.citation: Gerontologist. 2007 Feb;47(1):108-15
references.pmid: 17327546
references.citation: Med Care. 1994 May;32(5):508-25
references.pmid: 8182978
references.citation: Med Care. 2010 Apr;48(4):357-64
references.pmid: 20220535
references.citation: Gerontologist. 2009 Feb;49(1):68-80
references.pmid: 19363005
references.citation: Med Care. 2004 Nov;42(11):1040-8
references.pmid: 15586830
references.citation: Health Serv Res. 2010 Feb;45(1):79-97
references.pmid: 19878342