Outcomes management: A process for improving quality of care, staff and performance in a skilled nursing facility

The purpose of this study was to test the effectiveness of nurse-managed transitional care on the quality of care and functional ability of individuals following discharge from subacute units. Registered nurses employed on subacute units in a skilled nursing facility provided the nurse-managed transitional care. Using a quasi-experimental design, data were collected on admission to the subacute unit, at the time of discharge, 1 week following discharge, and 3 months following discharge on 242 treatment and comparison participants. The treatment group participants' overall function and quality of the care environment were significantly higher than the comparison group at 1 week and 3 months following discharge. Participants did not differ significantly on basic activities of daily living or number of readmissions.

Download Full-text

Does Investor-Ownership of Nursing Homes Compromise the Quality of Care?

International Journal of Health Services ◽

10.2190/ebcn-wecv-c0nt-676r ◽

2002 ◽

Vol 32 (2) ◽

pp. 315-325 ◽

Cited By ~ 32

Author(s):

Charlene Harrington ◽

Steffie Woolhandler ◽

Joseph Mullan ◽

Helen Carrillo ◽

David U. Himmelstein

Keyword(s):

Quality Of Care ◽

Nursing Homes ◽

Skilled Nursing Facility ◽

Nurse Staffing ◽

Care Quality ◽

Nursing Facilities ◽

Skilled Nursing ◽

Staffing Ratios ◽

The Impact

Quality problems have long plagued the nursing home industry. While two-thirds of U.S. nursing homes are investor-owned, few studies have examined the impact of investor-ownership on the quality of care. The authors analyzed 1998 data from inspections of 13,693 nursing facilities representing virtually all U.S. nursing homes. They grouped deficiency citations issued by inspectors into three categories (“quality of care,” “quality of life,” and “other”) and compared deficiency rates in investor-owned, nonprofit, and public nursing homes. A multivariate model was used to control for case mix, percentage of residents covered by Medicaid, whether the facility was hospital-based, whether it was a skilled nursing facility for Medicare only, chain ownership, and location by state. The study also assessed nurse staffing. The authors found that investor-owned nursing homes provide worse care and less nursing care than nonprofit or public homes. Investor-owned facilities averaged 5.89 deficiencies per home, 46.5 percent higher than nonprofit and 43.0 percent higher than public facilities, and also had more of each category of deficiency. In the multivariate analysis, investor-ownership predicted 0.679 additional deficiencies per home; chain-ownership predicted an additional 0.633 deficiencies per home. Nurse staffing ratios were markedly lower at investor-owned homes.

Download Full-text

Perceived Benefits, Barriers, and Drivers of Telemedicine From the Perspective of Skilled Nursing Facility Administrative Staff Stakeholders

Journal of Applied Gerontology ◽

10.1177/0733464816651884 ◽

2016 ◽

Vol 37 (1) ◽

pp. 110-120 ◽

Cited By ~ 13

Author(s):

Julia Driessen ◽

Nicholas G. Castle ◽

Steven M. Handler

Keyword(s):

Research Policy ◽

Skilled Nursing Facility ◽

Evidence Base ◽

Administrative Staff ◽

Joint Research ◽

Nursing Facility ◽

Skilled Nursing ◽

Avoidable Hospitalizations ◽

Unique Approach

Potentially avoidable hospitalizations (PAHs) of skilled nursing facility (SNF) patients are common and costly. Telemedicine represents a unique approach to manage and potentially reduce PAHs in SNFs, having been used in a variety of settings to improve coordination of care and enhance access to providers. Nonetheless, broad implementation and use of telemedicine lags in SNFs relative to other health care settings. To understand why, we surveyed SNF administrative staff attending a 1-day telemedicine summit. Participants saw the highest value of telemedicine in improving the quality of care and reducing readmissions. They identified hospital and managed care telemedicine requirements as primary drivers of adoption. The most significant barrier to adoption was the initial investment required. A joint research-policy effort to improve the evidence base around telemedicine in SNFs and introduce incentives may improve adoption and continued use of telemedicine in this setting.

Download Full-text