title: Medical staff involvement in nursing homes: development of a conceptual model and research agenda.
abstract: Medical staff (physicians, nurse practitioners, physicians' assistants) involvement in nursing homes (NH) is limited by professional guidelines, government policies, regulations, and reimbursements, creating bureaucratic burden. The conceptual NH Medical Staff Involvement Model, based on our mixed-methods research, applies the Donabedian "structure-process-outcomes" framework to the NH, identifying measures for a coordinated research agenda. Quantitative surveys and qualitative interviews conducted with medical directors, administrators and directors of nursing, other experts, residents and family members and Minimum Data Set, the Online Certification and Reporting System and Medicare Part B claims data related to NH structure, process, and outcomes were analyzed. NH control of medical staff, or structure, affects medical staff involvement in care processes and is associated with better outcomes (e.g., symptom management, appropriate transitions, satisfaction). The model identifies measures clarifying the impact of NH medical staff involvement on care processes and resident outcomes and has strong potential to inform regulatory policies.
authors.affiliation: Health Services, Policy & Practice, Brown University, Providence, RI, USA.
authors.forename: Renée
authors.initials: R
authors.lastname: Shield
authors.forename: Marsha
authors.initials: M
authors.lastname: Rosenthal
authors.forename: Terrie
authors.initials: T
authors.lastname: Wetle
authors.forename: Denise
authors.initials: D
authors.lastname: Tyler
authors.forename: Melissa
authors.initials: M
authors.lastname: Clark
authors.forename: Orna
authors.initials: O
authors.lastname: Intrator
mesh_terms: D006801:Humans; D008503:Medical Staff / Q000458:organization & administration; D016294:Models, Nursing; D015999:Multivariate Analysis; D009735:Nursing Homes / Q000592:standards; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care; D014481:United States
keywords: nursing home medical staff; organizational structure; outcomes of resident care; processes of nursing home care