title: Patient safety culture and the association with safe resident care in nursing homes.
abstract: OBJECTIVE
  Studies have shown that patient safety culture (PSC) is poorly developed in nursing homes (NHs), and, therefore, residents of NHs may be at risk of harm. Using Donabedian's Structure-Process-Outcome (SPO) model, we examined the relationships among top management's ratings of NH PSC, a process of care, and safety outcomes.
  
  
  METHODS
  Using top management's responses from a nationally representative sample of 3,557 NHs on the 2008 Nursing Home Survey on PSC, the Online Survey, Certification, and Reporting Database, and the Minimum Data Set, we examined the relationships among the three components of Donabedian's SPO model: structure (PSC), a process of care (physical restraints), and patient safety outcomes (residents who fell).
  
  
  RESULTS
  Results from generalized estimating equations indicated that higher ratings of PSC were significantly related to lower prevalence of physical restraints (odds ratio [OR] = 0.997, 95% confidence interval [CI] = 0.995-0.999) and residents who fell (OR = 0.999, 95% CI = 0.998-0.999). Physical restraint use was related to falls after controlling for structural characteristics and PSC (OR = 1.698, 95% CI = 1.619-1.781).
  
  
  CONCLUSIONS
  These findings can contribute to the development of PSC in NHs and promote improvements in health care that can be measured by process of care and resident outcomes.
authors.affiliation: Center for Gerontology and Healthcare Research, Brown University, Box G-S121(6), Providence, RI 02912, USA. Kali_Thomas@brown.edu
authors.forename: Kali S
authors.initials: KS
authors.lastname: Thomas
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hyer
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Castle
authors.forename: Laurence G
authors.initials: LG
authors.lastname: Branch
authors.forename: Ross
authors.initials: R
authors.lastname: Andel
authors.forename: Robert
authors.initials: R
authors.lastname: Weech-Maldonado
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D016001:Confidence Intervals; D006306:Health Surveys; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D008962:Models, Theoretical; D009735:Nursing Homes / Q000458:organization & administration*; D016017:Odds Ratio; D015279:Organizational Culture; D010043:Outcome and Process Assessment, Health Care; D061214:Patient Safety; D011787:Quality of Health Care / Q000458:organization & administration*; D012149:Restraint, Physical; D017751:Safety Management / Q000458:organization & administration*; D014481:United States