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Pressure ulcer development in the VA: Characteristics of nursing homes providing best care

AMERICAN JOURNAL OF MEDICAL QUALITY 1999年第1期14卷 39-44页

作者： Berlowitz, DR Anderson, JJ Brandeis, GH Lehner, LA Brand, HK Ash, AS Moskowitz, MA Bedford VA Hosp HSR&D Field Program Ctr Hlth Qual Outcomes & Econ Res Bedford MA 01730 USA Bedford VA Hosp Grp Management Sci Bedford MA 01730 USA Boston Med Ctr Hlth Care Res Unit Boston MA USA Boston Univ Sch Med Boston MA 02118 USA Boston Univ Sch Publ Hlth Boston MA USA

This study identifies structural characteristics of VA nursing homes that are associated with the best patient outcomes. We evaluated risk adjusted rates of pressure ulcer development in VA nursing homes and related these rates to facility size, staffing patterns, teaching nursing home status, and rural versus urban locale. Higher rates of pressure ulcer development were seen among urban teaching nursing homes and among nursing homes associated with both larger and smaller VA hospitals. Staffing patterns had a complex association with pressure ulcer development, and smaller nursing home staffs were not clearly associated with higher rates. For multivariate modeling, only hospital size and staffing remained significant independent predictors of pressure ulcer develop ment. These results emphasize that while structural characteristics of VA nursing homes can provide insights about care, improving the quality of care in this setting will require a much greater understanding how nursing homes are organized to meet patient needs.

关键词：规范老人疗养院/组织和管理老人疗养院/标准线性模型多元分析医护疗养所/组织和管理医护疗养所/标准结果评价(卫生保健) 压力性溃疡/流行病学美国/流行病学美国退伍军人事务部老年人人类

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Nursing home resident use of care directives

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JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES 1999年第5期54卷 M225-M229页

作者： Suri, DN Egleston, BL Brody, JA Rudberg, MA Univ Illinois Sch Publ Hlth Chicago IL USA

Background. The Patient Self-Determination Act of 1991 requires that nursing homes reimbursed by Medicare or Medicaid inform all residents upon admission of their rights to enact care directives in the event of terminal illness. This study investigated the relationship between care directive use and resident functional status. Methods. We analyzed a version of the Minimum Data Set (MDS+) from a single state. We selected residents who were admitted to a nursing home in the first half of 1993 and followed them in the nursing home through the end of 1994. We created logistic models to examine independent correlates associated with having an advance directive or a do-not-resuscitate (DNR) order on admission. We then created similar logistic models to examine independent correlates associated with writing an advance directive or DNR order subsequent to admission. Results. Of the 2,780 residents, 11% (292) had advance directives and 17% (466) had DNR orders upon admission. Of those without care directives upon admission, 6% (143) subsequently had an advance directive and 15% (339) subsequently had a DNR order. Cross-sectionally, older individuals and whites were more likely to have a care directive. Having poor cognitive and physical function was associated with having a DNR order upon admission. Longitudinally, longer stayers and whites were more likely to have an advance directive. residents who lost physical function were more likely to have an advance directive and those who lost cognitive function were more likely to have a DNR order. Conclusions. Care directive use is influenced by a number of sociodemographic and functional characteristics.

关键词：日常生活活动预先指示非洲裔美国人年龄因素认知/生理学认知障碍/病理生理学队列研究横断面研究欧洲大陆世系人群住院时间 Logistic模型纵向研究多元分析医护疗养所/组织和管理病人入院病人辩护/立法和法学复苏医嘱临终病人老年人老年人 80以上人类

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Health services administrator role delineation methodology: An Institutional Long-Term Care Example

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Evaluation & the Health Professions 1982年第2期5卷 170-199页

作者： Cyr, A. Bruce Foundation of the American College of Nursing Home Administrators United States

Health services administrators (HSA) are the cynosure of much current research because of their pivotal positions vis-à-vis quality of care and cost-effective policies. Role delineation methods used to date are too simple and/or too subjective to reflect the actual complexities of these roles. Dimensional anahl sis, as used to delineate complex organizational processes, more succinctly and accuratetly relfects these complexities and is more objetive. The inherent weakness of dimensional analisis in devising the initial list of tasks can be counteracted by, the use offact analysis. A set of L TC administrator tasks from a national study is dimensionally analized to produce a role delineation and the subroles are validated through Criterion analyses and amplified through reference to the literature. A similar strategy could usefully and readily be applied to extant data sets for other HSAs. © 1982, SAGE Publications. All rights reserved.

关键词：方差分析卫生设施负责人员医护疗养所/组织和管理角色作业完成和分析美国人类

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The Four Wall Syndrome: An Analysis of the Elderly in Relation to Seniors' Day Care

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Canadian Journal of Occupational Therapy 1978年第4期45卷 163-170页

作者： Kennedy, Myra S. Former Program Co-ordinator of Seniors' Day Care Geriatric Unit Withington Hospital Manchester England United Kingdom

A description of a pilot project in daytime care for the elderly and its results will provide the background for the presentation of the theory named “The Four Wall Syndrome”. This phrase was coined by the author to assist in the evaluation of the Day Care candidates and in the projection of the number of interviews as well as the type of interview techniques used when assessing the candidates for admission to a Seniors' Day Care program. The project began in May 1976, under the auspices of the New Brunswick Provincial Department of Social Services. Statistical proof of the project's success ensured its continuance for a second year. When the grant funds for the second year had been used, the Social Service Department decided to perpetuate Seniors' Day Care in the new package deal of community based services for the elderly in three key areas of New Brunswick. The ability of the program co-ordinator to apply “The Four Wall Syndrome” theory to interviews of candidates would assist in the screening process for admission to the program. It is believed that such a theory could be applicable to other programs for the elderly. © 1978, Canadian Association of Occupational Therapists (CAOT). All rights reserved.

关键词：老年人日间住院医疗/组织和管理新不伦瑞克医护疗养所/组织和管理病人入院试点项目人类

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Why nonprofit nursing homes pay higher nurses' salaries

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Nonprofit Management and Leadership 1991年第1期2卷 3-12页

作者： Holtmann, Alphonse Idson, Todd UniversityofMiami.

It is generally agreed that nonprofit nursing homes pay higher wages to their employees, hire more staff per patient, and are thus more costly than for‐profit nursing homes. We attempt to show that higher costs in nonprofit nursing homes are related to higher quality of care in these homes. Using the 1985 National Nursing Home Survey, we show that nurses in nonprofit nursing homes have different characteristics than nurses in for‐profit homes and that these differences in characteristics account for the differences in wages, a finding consistent with our hypothesis concerning quality differences between types of homes. Copyright © 1991 Wiley Periodicals, Inc., A Wiley Company

关键词：用户参与/经济学数据收集医护疗养所/经济学医护疗养所/人力医护疗养所/组织和管理护理人员/经济学护理人员/统计学和数值数据组织非盈利/经济学卫生保健质量/经济学薪金和附加福利美国

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"Teach us to pray": pastoral care of the new nursing home resident.

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Journal of pastoral care 1991年第2期45卷 169-175页

作者： Simmons, H.C. Presbyterian School of Christian Education Richmond 23227. VA United States

Discusses the many traumatic factors associated with leaving and entering a nursing home. Points to the significance of personal prayer in making such transitions, and offers specific guidelines for pastoral caregiver... 详细信息

关键词：适应心理学医护疗养所/组织和管理牧师心理治疗/方法病人入院社会支持美国老年人人类

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Organizational and provider structural changes and resource utilization of services for the elderly in norway

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Home Health Care Services Quarterly 1995年第3期15卷 31-46页

作者： Cates, Norman Business Administration Dominican College United States

This paper presents recent innovations in organizing provider work and changes in organizational structure that promote: (1) reduction in fragmentation of care (2) improved continuity and quality of care and (3) improved cost-containment efforts and (4) belter decision making. Data is also given on resource *** is anticipated that these models of care and services are prototypes of future models of care for the elderly as this population increases in number. Data is also presented (hat suggests that, eventually, increases in taxes and social security contributions and/or the rationing of health care may be necessary to meet pensioner health needs. © 1995 Taylor & Francis Group, LLC.

关键词：病人医护连续性数据收集卫生人员/统计学和数值数据老年人保健服务/组织和管理老年人保健服务/利用家庭医疗保健服务/组织和管理家庭医疗保健服务/利用保险健康模型组织管理国家卫生规划/组织和管理挪威医护疗养所/组织和管理医护疗养所/利用组织改革卫生保健质量老年人人类

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Fottler-smith: Theory of evaluating the effectiveness of nursing home administrators: An empirical analysis of determining dominant factors

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Health Marketing Quarterly 1989年第4期6卷 33-56页

作者： Rushinek, Avi Rushinek, Sara F. Department of Accounting University of Miami Coral Gables FL 33124 United States Department of Management Science University of Miami Coral Gables FL 33124 United States

In a recent issue of EVALUATION AND THE HEALTH PROFESSIONS, Fottler and Smith (1982)* developed a theory for determining the influence of Budgetary Evaluating the Effectiveness of Nursing Home Administration (EENA). The present study offers and extension to their multivariable theory, which is otherwise viewed as an excellent attempt at presenting a realistic model of EENA. Further analysis of the data included in the present paper ranks the dominant variables and factors as (1) Profit Per Patient Day (PPP) and Nursing Hours Per Patient Day (NH), (2) Other Hours Per Patient Day (OH) and Patient Mix (PM), (3) Occupancy Rate (OR) and Staffing Ratio (SR), (4) Administrator Years in Nursing Home Administration (AY) and Administrator Years at the Home (AYHII), (5) External Comparisons (EC) and Cost Per Patient Day (CPP) and (6) Administrative Intensity (AI) and Report Use (RU). In addition, this analysis reduces the multicolinearity and data redundancy of the original 14 variables by creating 6 less redundant factors from them. These new factors yield a EENA model of measurement with a fewer number of terms, a lower multicolinearity, and a multivariate normal distribution. The variable entitled Internal Comparisons (IC) is ranked as the most subordinate, and most dependent, while PPP is ranked as the most dominant variable. © 1989 Taylor & Francis Group, LLC.

关键词：加利福尼亚横断面研究评价研究因素分析统计学卫生设施负责人员/标准模型统计学医护疗养所/组织和管理研究设计

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Incident review management: a systemic approach to performance improvements.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1999年第6期21卷 21-27页

作者： Silver, M.S. [?]Mark Silver has a master's degree in political science and a doctorate in psychology and is a New York State-licensed social worker. He currently has a private consultation and clinical practice in New York City. Dr. Silver has worked in East Harlem as a psychiatric social worker in a dual diagnosis unit and as the quality assurance coordinator for a residential facility for developmentally disabled persons. He is working on a series of papers focusing on the practical utilization of IR management as a clinical and administrative tool for healthcare facilities. He first presented the model in New Orleans in 1999.

Incident reporting has emerged as a cornerstone of sound quality improvement programs. Sentinel events, "a serious and undesirable occurrence involving the loss of life, limb, or function of an individual served" (Joint Commission on Accreditation of Healthcare Organizations, 1996), is a mandated indicator for Joint Commission standards of accreditation for audited healthcare facilities. Properly investigated and documented individual incidents can lead to systemic improvements, which may enhance the quality of client care and the integrity of the healthcare facility. This article proposes a systemic approach to the incident review (IR) process in long-term healthcare facilities. This comprehensive approach incorporates identification, investigation, and management of the IR process from the inception of a problem to the continued follow-up to ensure that improvement plans are effectively implemented.

关键词：信息交流表格和记录管理纽约市医护疗养所/组织和管理医护疗养所/标准组织方针专家委员会质量保证卫生保健/方法质量保证卫生保健/组织和管理质量指标卫生保健危险处理/方法哨点监测人类

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Dissonance in the dining room: A study of social interaction in a special care unit

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QUALITATIVE HEALTH RESEARCH 1999年第1期9卷 133-155页

作者： Moore, KD Univ Wisconsin Sch Architectural & Urban Planning Inst Aging & Environm Milwaukee WI 53201 USA

This study is a multi-method, intrinsic case study of social interaction in a special care unit (SCU) for cognitively impaired older persons. It is found that residents are capable of developing a range of social bonds even though the SCU in question is found to have several organizational and physical factors that unwittingly thwart its therapeutic potential. These limitations are illuminated by consideration of the congruence between the conceptualization of the dining areas held by staff and that held by residents as revealed throught the process of negotiation occurring in social interaction. The study adopts an enviornment-behavior perspective following the theoretical development of Lawton (1986) and merges it with the qualitative approach to place pursued by Goffman (1961) and Gubrium (1978). It is suggested that a focus on place as a unit of analysis offers potential for bridging Qualify of Life with the cognitively impaired.

关键词：日常生活活动痴呆摄食行为医护疗养所/组织和管理社会环境人类

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