Surveying Multiple Health Professional Team Members Within Institutional Settings

Clark, Melissa A.; Roman, Anthony; Rogers, Michelle L.; Tyler, Denise; Mor, Vincent

doi:10.1177/0163278714521633

Cited by 11 publications

(24 citation statements)

References 59 publications

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“…No nonresponse bias was detected. 22 Some completed abbreviated surveys (5.6% of DONs and 2.5% of NHAs), and no significant differences between respondents with abbreviated versus full surveys were identified. 22 …”

Section: Methodsmentioning

confidence: 92%

Does the Introduction of Nursing Home Culture Change Practices Improve Quality?

Miller¹,

Lepore

Lima³

et al. 2014

J American Geriatrics Society

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Objectives To understand whether nursing home (NH) introduction of culture change practices is associated with improved quality Design NH-level panel study using multivariate fixed-effects statistical modeling to estimate the effect of culture change introduction on quality outcomes Setting and Participants 824 U.S. NHs with culture change practice involvement beginning between 2005 and 2010 Measurements A culture change practice score (derived from a 2009/10 national NH survey) was used to stratify analyses by NHs with high practice implementation (scores in the top quartile; n=217) versus other NHs (n=607). NH-level outcomes included 1) prevalence of seven care practices and three resident outcomes; 2) a NH’s health-related and quality-of-life weighted survey deficiencies; and, 3) the average number of hospitalizations per resident year. Results For NHs with high practice implementation, introduction of culture change was associated with a significant decrease in the prevalence of restraints, tube feeding and pressure ulcers; an increase in the proportion of residents on bladder training programs; and, a small decrease in the average number of hospitalizations per resident year (coefficient −0.04, standard error (SE) 0.022; p=0.06). For NHs having lower practice implementation (practice scores in lower-three quartiles), introduction was associated with fewer health-related (coefficient −5.26; SE 3.05; p=0.09) and quality-of-life (coefficient −0.10; SE 0.049; p=0.04) survey deficiencies. However, these NHs also had small statistically significant increases in the prevalence of residents with urinary tract infections and in the average hospitalizations per resident year (coefficient 0.03; SE 0.014; p=0.02). Conclusion The introduction of NH culture change appears to result in significant improvements in some care processes and outcomes in NHs having high practice implementation. For other NHs, culture change introduction results in fewer survey deficiencies.

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Section: Methodsmentioning

confidence: 92%

Does the Introduction of Nursing Home Culture Change Practices Improve Quality?

Miller¹,

Lepore

Lima³

et al. 2014

J American Geriatrics Society

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“…24 A DON contact was identified at 3695 of these facilities. Surveys were completed between August 2009 and April 2011.…”

Section: Setting and Samplementioning

confidence: 99%

“…No nonresponse bias was detected. 24 For this study 170 facilities (7.8%) were dropped because of (nonimputed) missing data for PC items (n = 1995). Those NHs removed were similar to those that remained except that they were less likely to have special care units ( p < 0.05).…”

Section: Setting and Samplementioning

confidence: 99%

End-of-Life Care in Nursing Homes with Greater versus Less Palliative Care Knowledge and Practice

Miller

Lima

Thompson

2015

Journal of Palliative Medicine

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Background: Many older adults in nursing homes (NHs) lack palliative care (PC) access; but little is known about whether access to PC knowledge and practice (beyond hospice) impacts residents' care. Objective: The study objective was to evaluate how differing levels of NH PC knowledge and practice are associated with residents' end-of-life health care use. Results: Controlling for NH hospice use, being in a NH with higher PC care knowledge scores was associated with residents having a higher likelihood of documented six-month prognoses and lower likelihoods of having feeding tubes, injections, restraints, suctioning, and end-of-life hospital and ER use. Being in a NH with higher PC practice scores was associated with a lower likelihood of having feeding tubes and ER visits. Conclusion: Policies and advocacy promoting the development of NH PC knowledge and practices could potentially improve care and reduce hospital and ER use.

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“…Adjusting for the complex stratified sampling frame, the NHs that answered one or both surveys are representative of the U.S. NH population (Shaping Long-Term Care in America). 34 …”

Section: Methodsmentioning

confidence: 99%

Physicians in Nursing Homes: Effectiveness of Physician Accountability and Communication

Lima

Intrator

Wetle

2015

Journal of the American Medical Directors Association

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Objectives To develop a measure of the perceptions of nursing home (NH) Directors of Nursing (DON) on the adequacy of physician care and to examine its variation as well as its construct validity. Design A nationwide cross-sectional study with primary data collection Setting 2043 NHs surveyed August 2009 – April 2011 Participants Directors of Nursing (DONs) and NH Administrators responded to questions pertaining to their perceptions of the care provided by physicians in their NH. Measurements Ten items were used to create three domains: medical staff attentiveness, physician communication, and staff concerns about physician practice. These were combined into an overall summary score measure called “Effectiveness of Physician Accountability and Communication” (EPAC). EPAC construct validity was ascertained from other DON questions and from a complementary survey of NH Administrators. RESULTS The established EPAC score is the first measure to capture specific components of the adequacy of physician care in NHs. EPAC exhibited good construct validity: more effective practices were correlated with greater physician involvement in discussions of Do-Not-Resuscitate orders, the frequency that the Medical Director checked on the medical care delivered by attending physician, the tightness of nursing home's control of its physician resources, and the DON's perception of whether or not avoidable hospitalizations and ER visits could be reduced with greater physician attention to resident needs. Conclusion As increased attention is given to the quality of care provided to vulnerable elders, effective measures of processes of care are essential. The EPAC measure provides an important new metric that can be used in these efforts. The goal is that future studies could use EPAC and its individual domains to shed light on the manner through which physician presence is related to resident outcomes in the NH setting.

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Surveying Multiple Health Professional Team Members Within Institutional Settings

Cited by 11 publications

References 59 publications

Does the Introduction of Nursing Home Culture Change Practices Improve Quality?

Does the Introduction of Nursing Home Culture Change Practices Improve Quality?

End-of-Life Care in Nursing Homes with Greater versus Less Palliative Care Knowledge and Practice

Physicians in Nursing Homes: Effectiveness of Physician Accountability and Communication

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