Division of Health and Environment, Abt Associates, Durham, North Carolina, USA.
Division of Nursing Homes, Centers for Medicare & Medicaid Services, Baltimore, Maryland, USA.
J Am Geriatr Soc. 2022 Sep;70(9):2508-2516. doi: 10.1111/jgs.17843. Epub 2022 May 7.
Staff turnover is considered an important indicator of nursing home quality. We used auditable staffing data from the Centers for Medicare & Medicaid Services (CMS) Payroll-Based Journal (PBJ) system to calculate turnover measures for nurse staff and administrators and examined the relationship between turnover and nursing home quality.
Our analyses included data from 13,631 nursing homes that submitted complete staffing data through PBJ for 2018Q3 - 2019Q4. We identified turnover based on gaps in days worked by eligible employees, allowing us to calculate turnover measures that do not depend on termination dates reported by nursing homes, which are not captured in PBJ. We linked staff turnover measures to nursing home quality measures and star ratings published on CMS' Care Compare website in January 2020 and examined the relationship between turnover and quality of care. We used ordinary least squared models for continuous outcomes and ordered logit models for categorical outcomes, controlling for facility, and county characteristics.
Mean annual turnover rates were about 44% for RNs and 46% for total nurse staff. On average, there was one administrator leaving each nursing home during this period although about half of nursing homes had no administrator turnover. Turnover rates varied greatly across nursing homes. For-profit and larger nursing homes had higher turnover rates. Higher turnover was consistently associated with lower quality of care.
Our study highlights the importance of staff turnover due to its relationship to nursing home quality. In January 2022, CMS started posting turnover measures on Care Compare to allow consumers to use this information in their assessment of nursing home quality and to motivate nursing homes to implement innovative strategies to retain staff. While these actions are challenging, they are nonetheless warranted for improving the quality of care for nursing home residents.
员工流动率被认为是养老院质量的一个重要指标。我们使用医疗保险和医疗补助服务中心（CMS）薪资基日报表（PBJ）系统的可审计人员配置数据，计算护士和管理人员的流动率指标，并研究流动率与养老院质量之间的关系。
我们的分析包括了通过 PBJ 提交 2018 年第三季度至 2019 年第四季度完整人员配置数据的 13631 家养老院的数据。我们根据符合条件的员工工作天数的差距来确定流动率，从而可以计算不依赖于养老院报告的离职日期的流动率指标，这些日期在 PBJ 中无法捕捉到。我们将员工流动率指标与 CMS“护理比较”网站上发布的养老院质量指标和星级评级联系起来，并研究流动率与护理质量之间的关系。我们使用普通最小二乘法模型进行连续结果分析，使用有序逻辑回归模型进行分类结果分析，同时控制了设施和县特征。
注册护士的年平均流动率约为 44%，护士总数的流动率约为 46%。在此期间，平均每个养老院有一名管理人员离职，尽管约有一半的养老院没有管理人员流动。养老院之间的流动率差异很大。营利性和较大的养老院流动率较高。较高的流动率与较低的护理质量始终相关。
我们的研究强调了员工流动率的重要性，因为它与养老院质量有关。2022 年 1 月，CMS 开始在“护理比较”上发布流动率指标，以允许消费者在评估养老院质量时使用这些信息，并激励养老院实施创新策略来留住员工。虽然这些行动具有挑战性，但为了提高养老院居民的护理质量，这些行动是必要的。
