JAMDA
Volume 10, Issue 7 , Pages 498-504, September 2009

Medical Staff Organization in Nursing Homes: Scale Development and Validation

  • Paul R. Katz, MD

      Affiliations

    • University of Rochester, Rochester, NY
    • Canandaigua VA Medical Center
    • Corresponding Author InformationAddress correspondence to Paul R. Katz, MD, University of Rochester School of Medicine and Dentistry, 435 East Henrietta, Rochester, NY 14620.
    • ,
  • Jurgis Karuza, PhD

      Affiliations

    • University of Rochester, Rochester, NY
    • State University of New York College at Buffalo, Buffalo, NY
    • ,
  • Orna Intrator, PhD

      Affiliations

    • Brown University, Providence, RI
    • ,
  • Jacqueline Zinn, PhD

      Affiliations

    • Temple University, Philadelphia, PA
    • ,
  • Vincent Mor, PhD

      Affiliations

    • Brown University, Providence, RI
    • ,
  • Thomas Caprio, MD

      Affiliations

    • University of Rochester, Rochester, NY
    • ,
  • Anthony Caprio, MD

      Affiliations

    • University of North Carolina at Chapel Hill, NC
    • ,
  • Jason Dauenhauer, PhD

      Affiliations

    • Brockport State College, Brockport, NY
    • ,
  • Julie Lima, PhD

      Affiliations

    • Brown University, Providence, RI

published online 06 August 2009.

Purpose

To construct a multidimensional self-report scale to measure nursing home (NH) medical staff organization (NHMSO) dimensions and then pilot the scale using a national survey of medical directors to provide data on its psychometric properties.

Design and Methods

Instrument development process consisting of the proceedings from the Nursing Home Physician Workforce Conference and focus groups followed by cognitive interviews, which culminated in a survey of a random sample of American Medical Directors Association (AMDA) affiliated medical directors. Analyses were conducted on surveys matched to Online Survey Certification and Reporting (OSCAR) data from freestanding nonpediatric nursing homes. A total of 202 surveys were available for analysis and comprised the final sample.

Results

Dimensions were identified that measured the extent of medical staff organization in nursing homes and included staff composition, appointment process, commitment (physiciancohesion; leadership turnover/capability), departmentalization (physician supervision, autonomy and interdisciplinary involvement), documentation, and informal dynamics. The items developed to measure each dimension were reliable (Cronbach's alpha ranged from 0.81 to 0.65).Intercorrelations among the scale dimensions provided preliminary evidence of the construct validity of the scale.

Implications

This report, for the first time ever, defines and validates NH medical staff organization dimensions, a critical first step in determining the relationship between physician practice and the quality of care delivered in the NH.

Keywords: Nursing home, medical staff, organization, quality of care

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 Supported by the: NIA R-21 AGO25246 and HRSA 5D31HP70118-05 grants.The authors have no conflicts of interest relating to this article.

PII: S1525-8610(09)00115-7

doi:10.1016/j.jamda.2009.04.002

JAMDA
Volume 10, Issue 7 , Pages 498-504, September 2009

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