title: Relationship between structural characteristics and outcome quality indicators at health care facilities for the elderly requiring long-term care in Japan from a nationwide survey.
abstract: OBJECTIVE
  To clarify the performance situation of selected quality indicators: falls, pressure ulcers and dehydration, at health care facilities for the elderly in Japan, and what structural characteristics are related to them.
  
  
  METHODS
  The operational population consisted of 1057 institutionalized users (approximately 10 randomly selected per facility) from a survey answered by the care staff. The facilities were divided into two groups according to their prevalence of negative outcomes (falls, pressure ulcers, dehydration): the best 25% (the very good performers) and the remaining 75% (not so good performers). Logistic regression analysis was carried out to examine the relationship between the structure characteristics of the facilities and their performance regarding each quality indicator.
  
  
  RESULTS
  After controlling for sex, years of operation and average age of the users, our results showed a beneficial significant relationship between falls and the total number of nurses per 100 users with an adjusted odds ratio (AOR) of 0.77 (95% CI 0.59-0.98); In contrast, for pressure ulcers, harmful associations between a higher number of registered nurses (AOR 1.23, 95% CI 1.01-1.05) and the availability of 24-h nurse staffing (AOR 4.95, 95% CI 1.19-24.91) were found; regarding dehydration, we did not find any related staffing characteristics.
  
  
  CONCLUSIONS
  Nursing staff might be considered as a potentially related variable in the quality of care in health care facilities for the elderly. The present study is the first to show a relationship between structural characteristics and quality outcomes in health care facilities for the elderly.
authors.affiliation: Department of Health Services Research, Graduate School of Comprehensive Human Sciences, Tsukuba, Ibaraki.
authors.forename: Felipe Alfonso
authors.initials: FA
authors.lastname: Sandoval Garrido
authors.forename: Nanako
authors.initials: N
authors.lastname: Tamiya
authors.forename: Masayo
authors.initials: M
authors.lastname: Kashiwagi
authors.forename: Sumiko
authors.initials: S
authors.lastname: Miyata
authors.forename: Jiro
authors.initials: J
authors.lastname: Okochi
authors.forename: Yoko
authors.initials: Y
authors.lastname: Moriyama
authors.forename: Yui
authors.initials: Y
authors.lastname: Yamaoka
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Takamuku
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006268:Health Facilities / Q000592:standards*; D006801:Humans; D007564:Japan; D008134:Long-Term Care / Q000592:standards*; D008297:Male; D063868:Patient Outcome Assessment; D019984:Quality Indicators, Health Care
keywords: aged; long-term care; personnel staffing; quality indicators; quality of health care