| Quality of care in nursing homes is of concern to consumers, providers, policy makers, and researchers. In this study, 1996 OSCAR and OSHPD data were used from 883 California nursing homes to identify structural organizational characteristics that were predictive of a risk-adjusted pressure sore prevalence rate and receipt of a survey deficiency related to pressure sore prevention and treatment. Multiple regression was used to analyze a model of clinical resident characteristics that were predictive of the pressure sore prevalence rate (R-squared =.44). The residual from the regression was then used in two analyses. A negative residual = a lower-than-expected pressure sore prevalence rate and a positive residual = a higher-than-expected rate. A multiple regression analysis revealed that structural organizational characteristics of home that were predictive of the residual included licensed nurse average hourly wage, total licensed nurse hours per resident day, total dietary staff hours per resident day, nursing facilities (NF) with a distinct part, and NFs as compared to dually certified SNF/NFs. However, these predictors explained little of the variation in the residual (R-squared = 0.04). A logistic regression analysis revealed the estimated odds ratios that a facility was 1.07 times more likely to receive a deficiency with a positive residual, 1.95 times more likely if the facility was greater than 160 beds as compared to 60–120 beds, 1.5 times more likely if certified as a NF with a distinct part,.32 times less likely if certified as a NF only as compared to dually certified SNF/NFs, and.64 times less likely with a higher CNA per resident ratio. The likelihood of receiving a deficiency increased if the facility was surveyed by personnel from the district offices of San Bernardino (2.6 times), Orange (3.1 times), San Diego (7.3 times), San Francisco (3.4 times), or Riverside (3.5 times) as compared to facilities surveyed by personnel from the Los Angeles district office. Future studies on nursing staff characteristics, processes of care, and surveyor practices are recommended.; This project was supported by grant number R03 HSI 0022 from the Agency for Health Care Policy and Research. |
