Richard Baldwin, RN, AssDipNursAdmin, BHlthAdmin, MBA, PhD, FCHSM, is Associate, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia. E-mail:
Health Care Manage Rev. 2017 Oct/Dec;42(4):315-327. doi: 10.1097/HMR.0000000000000116.
Theory suggests that structural factors such as aged care facility size (bed numbers) will influence service quality. There have been no recent published studies in support of this theory, and consequently, the available literature has not been useful in assisting decision makers with investment decisions on facility size.
The study aimed to address that deficit by reviewing the international literature on the relationships between the size of residential aged care facilities, measured by number of beds, and service quality.
A systematic review identified 30 studies that reported a relationship between facility size and quality and provided sufficient details to enable comparison. There are three groups of studies based on measurement of quality-those measuring only resident outcomes, those measuring care and resident outcomes using composite tools, and those focused on regulatory compliance.
The overall findings support the posited theory to a large extent, that size is a factor in quality and smaller facilities yield the most favorable results. Studies using multiple indicators of service quality produced more consistent results in favor of smaller facilities, as did most studies of regulatory compliance.
The theory that aged care facility size (bed numbers) will influence service quality was supported by 26 of the 30 studies reviewed.
The review findings indicate that aged care facility size (number of beds) may be one important factor related to service quality. Smaller facilities are more likely to result in higher quality and better outcomes for residents than larger facilities. This has implications for those who make investment decisions concerning aged care facilities. The findings also raise implications for funders and policy makers to ensure that regulations and policies do not encourage the building of facilities inconsistent with these findings.
理论表明，结构因素，如养老院规模（床位数）将影响服务质量。没有最近发表的研究支持这一理论，因此，现有的文献对于决策者在设施规模投资决策方面并没有帮助。
本研究旨在通过审查有关养老院规模（以床位数衡量）与服务质量之间关系的国际文献来弥补这一不足。
系统评价确定了 30 项研究，这些研究报告了设施规模与质量之间的关系，并提供了足够的细节进行比较。根据质量测量有三组研究——仅测量居民结果的研究、使用综合工具测量护理和居民结果的研究以及专注于监管合规性的研究。
总体发现在很大程度上支持了假设的理论，即规模是质量的一个因素，较小的设施产生最有利的结果。使用多种服务质量指标的研究产生了更一致的结果，有利于较小的设施，而大多数监管合规性研究也是如此。
养老院规模（床位数）将影响服务质量的理论得到了 30 项综述研究中的 26 项支持。
审查结果表明，养老院规模（床位数）可能是与服务质量相关的一个重要因素。较小的设施比较大的设施更有可能为居民带来更高的质量和更好的结果。这对那些负责养老院投资决策的人具有重要意义。这些发现还对资金提供者和政策制定者提出了要求，以确保法规和政策不鼓励建造不符合这些发现的设施。
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