Objectives
Little is known about the relationship between how medical care is organized and delivered
in nursing homes. Taking a lead from the acute care arena, we hypothesize that nursing
home medical staff organization (NHMSO) is an important predictor of clinical outcomes
in the nursing home.
Methods
A total of 202 usable surveys from a 2-wave survey process using the Dillman Method
were returned from medical directors who were randomly selected from the AMDA membership
and were asked to fill out a survey on the structure of medical organization in their
primary nursing home practice. Quality measures that are likely to be affected by
physician practice patterns were culled from NH Compare and OSCAR data sets and matched
to the physician surveys, ie, long stay residents’ prevalence of pain, restraint use,
catheter use, pressure ulcers, pneumococcal vaccination, influenza vaccination, presence
of advanced directives, prescription of antibiotics, and prevalence of depression.
Results
Using a series of hierarchical multiple regressions, significant R2 changes were found when the medical staff organization dimensions were added in the
regressions after controlling for nursing home structural characteristics for the
following outcomes: pneumococcal vaccination and restraint use. Near significant findings
were noted for pain prevalence among long-stay residents, catheter use, and prevalence
of pressure ulcers.
Conclusions
This study is the first to demonstrate a relationship between medical staff organizational
dimensions and clinical outcomes in the nursing home setting and as such represents
an initial “proof of concept.” NHMSO should be considered as a potentially important
mediating or moderating variable in the quality of care equation for nursing homes.
Keywords
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Article info
Publication history
Published online: October 08, 2010
Footnotes
Funding source: National Institute on Aging R21 AG025246.
Identification
Copyright
© 2011 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
