Arling Greg, Kane Robert L, Mueller Christine, Bershadsky Julie, Degenholtz Howard B
Indiana University Center for Aging Research, Regenstrief Institute, HITS Building Room 2000, 410 West 10 Street, Indianapolis, IN 46202-3012, USA.
Gerontologist. 2007 Oct;47(5):672-82. doi: 10.1093/geront/47.5.672.
The purpose of this study was to determine the relationship between nursing home staffing level, care received by individual residents, and resident quality-related care processes and functional outcomes.
Nurses recorded resident care time for 5,314 residents on 156 units in 105 facilities in four states (Colorado, Indiana, Minnesota, and Mississippi). We linked residents' care times to their measures of health and functioning from Minimum Data Set assessments. Major variables were unit- and resident-specific minutes of care per day, process measures (physical restraints, range of motion, toileting program, and training in activities of daily living [ADLs]), outcome measures (ADL decline, mobility decline, and worsening behavior between the time study and 90-day follow-up), and covariates such as unit type and resident health status. We used multilevel analysis to examine staffing and quality relationships.
Residents with toileting programs, range of motion or ADL training, and restraints received significantly more care from unlicensed but not from licensed staff. However, functional outcomes were not significantly related to care received from licensed or unlicensed staff, except for ADL decline, which was greatest for residents receiving more unlicensed minutes of care. Unit staffing level (licensed and unlicensed) was unrelated to any of the care processes or outcome measures, although higher overall staffing was associated with more time devoted to direct resident care.
Future research into nursing home quality should focus on organization and delivery rather than simply the amount of care available.
本研究的目的是确定疗养院人员配备水平、个体居民接受的护理以及与居民质量相关的护理流程和功能结局之间的关系。
护士记录了四个州（科罗拉多州、印第安纳州、明尼苏达州和密西西比州）105家疗养院156个单元中5314名居民的护理时间。我们将居民的护理时间与其在最低数据集评估中的健康和功能指标相关联。主要变量包括每个单元和居民每天的护理分钟数、流程指标（身体约束、活动范围、如厕计划以及日常生活活动[ADL]训练）、结局指标（ADL下降、活动能力下降以及在研究期间至90天随访期间行为恶化）以及诸如单元类型和居民健康状况等协变量。我们使用多水平分析来研究人员配备与质量之间的关系。
接受如厕计划、活动范围或ADL训练以及受到约束的居民从无执照工作人员那里获得的护理显著更多，但从有执照工作人员那里获得的护理并非如此。然而，功能结局与从有执照或无执照工作人员那里获得的护理并无显著关联，不过ADL下降除外，接受更多无执照护理分钟的居民ADL下降最为明显。单元人员配备水平（有执照和无执照）与任何护理流程或结局指标均无关联，尽管总体人员配备较高与投入直接居民护理的时间更多相关。
未来对疗养院质量的研究应关注组织和提供护理的方式，而不仅仅是可获得的护理量。
