title: Study of Individualization and Bias in Nursing Home Fall Prevention Practices.
abstract: OBJECTIVE
  Little is known about how nursing home staff use resident characteristics to individualize care delivery or whether care is affected by implicit bias.
  
  
  METHODS
  Randomized factorial clinical vignette survey.
  
  
  METHODS
  Sixteen nursing homes in North Carolina.
  
  
  METHODS
  Nursing, rehabilitation, and social services staff (n = 433).
  
  
  METHODS
  Vignettes describing hypothetical residents were generated from a matrix of clinical and demographic characteristics. Resident age, race and gender were suggested by a photo. Participants completed up to four randomly assigned vignettes (n = 1615), rating the likelihood that 12 fall prevention activities would be used for the resident. Fixed and random effects mixed model analysis examined the impact of vignette resident characteristics and staff characteristics on four intervention categories.
  
  
  RESULTS
  Staff reported a higher likelihood of fall prevention activities in all four categories for residents with a prior fall (0.2-0.5 points higher, 10 point scale, P < 0.05), but other risk factors did not affect scores. There was little evidence of individualization; only dementia increased the reported likelihood of environmental modification (0.3, P < 0.001, 95% CI 0.2-0.5). Individualization did not vary with staff licensure category or clinical experience. Registered nurses consistently reported higher likelihoods of all fall prevention activities than did licensed practical nurses, unlicensed staff and other professional staff (1.0-2.7 points, P < 0.001 to 0.005). There was a small degree of implicit racial bias; staff indicated that environmental modification would be less likely to occur in otherwise identical vignettes including a photo of a black rather than a white resident (-0.2 points, 95% CI -0.3 to -0.1).
  
  
  CONCLUSIONS
  Nursing home staff report a standardized approach to fall prevention without individualization. We found a small impact from implicit racial bias that should be further explored.
authors.affiliation: School of Medicine, Duke University, Durham, North Carolina.|Durham VA Geriatric Research Education and Clinical Center, Durham, North Carolina.
authors.forename: Cathleen S
authors.initials: CS
authors.lastname: Colón-Emeric
authors.affiliation: School of Medicine, Duke University, Durham, North Carolina.|Durham VA Geriatric Research Education and Clinical Center, Durham, North Carolina.|School of Nursing, Duke University, Durham, North Carolina.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Corazzini
authors.affiliation: School of Nursing, Duke University, Durham, North Carolina.
authors.forename: Eleanor
authors.initials: E
authors.lastname: McConnell
authors.affiliation: School of Nursing, Duke University, Durham, North Carolina.
authors.forename: Wei
authors.initials: W
authors.lastname: Pan
authors.affiliation: School of Nursing, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Mark
authors.initials: M
authors.lastname: Toles
authors.affiliation: School of Medicine, Duke University, Durham, North Carolina.|Durham VA Geriatric Research Education and Clinical Center, Durham, North Carolina.
authors.forename: Rasheeda
authors.initials: R
authors.lastname: Hall
authors.affiliation: School of Nursing, Duke University, Durham, North Carolina.
authors.forename: Melissa
authors.initials: M
authors.lastname: Batchelor-Murphy
authors.affiliation: School of Nursing, Duke University, Durham, North Carolina.
authors.forename: Tracey L
authors.initials: TL
authors.lastname: Yap
authors.affiliation: School of Nursing, Duke University, Durham, North Carolina.
authors.forename: Amber L
authors.initials: AL
authors.lastname: Anderson
authors.affiliation: School of Nursing, Duke University, Durham, North Carolina.
authors.forename: Andrew
authors.initials: A
authors.lastname: Burd
authors.affiliation: School of Nursing, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Anderson
mesh_terms: D000056:Accident Prevention; D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015982:Bias; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D009735:Nursing Homes / Q000706:statistics & numerical data*; D012307:Risk Factors
keywords: bias; clinical vignettes; fall prevention; nursing homes; person-centered care