| Identifying and learning from nursing homes that are able to consistently provide high quality care to their residents is of great interest to policy makers, nursing home industry stakeholders, and nursing home staff. Previous studies have shown relationships between various organizational characteristics and outcome measures, often with conflicting results. This analysis explores relationships between commonly cited nursing home characteristics and high performance on the CMS publicly reported quality measures of physical restraints, high-risk pressure ulcers, chronic care pain, and post-acute care pain using stepwise multivariate logistic regression. One-year rolling average scores were calculated and compared to the high-performance tenth percentile for the baseline period. Preliminary univariate logistic regression showed significant associations between many characteristics and the high performance outcomes. Multivariate models demonstrated fair predictability as assessed by the c-index, but good fit was obtained only with the model for physical restraints. Models for high-risk pressure ulcers and post-acute care pain showed fair goodness of fit, and a good fit was not achieved for chronic care pain. Some characteristics produce opposite effects across the four outcomes, making it difficult for an individual nursing home to achieve high performance across multiple measures. It may not be desirable, or even possible, to change some of these factors, such as staffing levels or urban location. Recent studies emphasize the role of organizational culture on improving the quality of care. Reliable metrics for many of these characteristics, such as support of leadership and staff stability are not yet available. Learning networks such as the Advancing Excellence in America's Nursing Home Campaign provide a platform for nursing home staff to access and implement best practices, as well as explore the development of additional process measures. Expected changes to outcome measures and development of uniform process measures will provide new directions for further investigation and potentially lead to greater understanding of the links between nursing home characteristics and the ability to provide good quality care. |
