Spector W D, Takada H A
Agency for Health Care Policy and Research.
J Aging Health. 1991 Nov;3(4):427-54. doi: 10.1177/089826439100300401.
Although there has been increased interest in using outcomes as measures of quality, few studies have shown a link between structure or process and outcomes. In this analysis, based on approximately 2,500 residents in 80 nursing homes in Rhode Island, multivariate models estimate which aspects of care are associated with resident outcomes after controlling for resident characteristics. Outcomes, measured over a 6-month period included death, functional decline, and functional improvement. Results suggest that higher staff levels and lower RN turnover were related to functional improvement. Facilities with high catheter use, low rates of skin care, and low participation in organized activities were associated with negative outcomes. Facilities with few private-pay residents were also associated with negative outcomes. Receipt of a serious federal citation was associated with improved outcomes. For-profit facilities appeared to be more efficient in use of resources.
尽管人们越来越关注将结果作为质量衡量标准，但很少有研究表明结构或过程与结果之间存在联系。在这项分析中，基于罗德岛州80家养老院的约2500名居民，多变量模型估计了在控制居民特征后，护理的哪些方面与居民结果相关。在6个月期间测量的结果包括死亡、功能衰退和功能改善。结果表明，较高的员工水平和较低的注册护士离职率与功能改善有关。导管使用率高、皮肤护理率低以及参加有组织活动的参与度低的机构与负面结果相关。自费居民较少的机构也与负面结果相关。收到严重的联邦罚单与结果改善相关。营利性机构在资源利用方面似乎更有效率。
