• Login
    View Item 
    •   UMB Digital Archive
    • School, Graduate
    • Theses and Dissertations All Schools
    • View Item
    •   UMB Digital Archive
    • School, Graduate
    • Theses and Dissertations All Schools
    • View Item
    JavaScript is disabled for your browser. Some features of this site may not work without it.

    Browse

    All of UMB Digital ArchiveCommunitiesPublication DateAuthorsTitlesSubjectsThis CollectionPublication DateAuthorsTitlesSubjects

    My Account

    LoginRegister

    Statistics

    Display statistics

    Acuity-based staffing in long term care: Does it influence quality?

    • CSV
    • RefMan
    • EndNote
    • BibTex
    • RefWorks
    Find Full text
    Author
    Gray-Siracusa, Kathy
    Advisor
    Johantgen, Mary E.
    Date
    2005
    Type
    dissertation
    
    Metadata
    Show full item record
    Abstract
    Background. Long-term care settings have frequently been targeted as environments prone to deficiencies in quality and resultant negative effects on resident safety. The use of minimum nurse staffing ratios has been proposed as a way to improve the quality of care for long-term care residents. However, the American Nursing Association has criticized the appropriateness of ratios for the determination of staffing needs. A more appropriate staffing methodology is one that is based on a measure of intensity that takes into consideration the aggregate population of patients and the associated roles and responsibilities of the nursing staff. The purpose of this study is threefold: (1) to determine the difference between the hours of care required by residents and reported staffing, (2) to examine whether differences can be explained by organizational characteristics, and (3) to determine if differences influence the quality of resident care. Methods. A descriptive/correlational analysis was performed using a cross-section of the administrative data contributed by Ohio nursing homes to both CMS's Online Survey and Reporting Systems (OSCAR) and the Minimum Data Set version 2.0 (MDS 2.0) in 2000. The resulting sample was 690 facilities. Acuity-based staffing was calculated using the RUG-III groupings and standardized times obtained from the Center for Medicaid and Medicare Services (CMS). Quality measures were aggregated to the nursing home level using indicators derived from the CMS Minimum Data Set and deficiencies reported in OSCAR. Findings. Acuity-based Total Nurse staffing was found to be significantly higher (4.07 hours per patient day) than reported Total Nurse staffing (3.46 hours per resident day). More than 70% of the Ohio nursing homes have lower staffing than that required based on acuity. Non-profit ownership status was reflective of higher amount of staffing in all categories (RN, LPN, NA, total). The difference between reported staffing and calculated staffing had a significant influence on the prevalence of no range of motion (ROM), the use of antipsychotics, and pressure ulcers. Similarly, the staffing difference influenced the variation in the number of cited deficiencies and the number of substandard quality of care deficiencies. Conclusions. Acuity-based staffing approaches would likely increase the demand for nursing staff in nursing homes where shortages are already common. Only 30% of Ohio nursing homes would be considered to have enough nursing staff if staffing standards were based on RUG-III acuity and time estimates. As negative differences between reported and acuity-based staffing increased, several quality outcomes were found to be negatively influenced, even controlling for organizational characteristics such as profit, size, location, and percent Medicaid.
    Description
    University of Maryland, Baltimore. Nursing. Ph.D. 2005
    Keyword
    Health Sciences, Nursing
    Health Sciences, Health Care Management
    Nursing Homes--manpower
    Personnel Staffing and Scheduling--standards
    Ohio
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/1100
    Collections
    Theses and Dissertations All Schools
    Theses and Dissertations School of Nursing

    entitlement

     
    DSpace software (copyright © 2002 - 2023)  DuraSpace
    Quick Guide | Policies | Contact Us | UMB Health Sciences & Human Services Library
    Open Repository is a service operated by 
    Atmire NV
     

    Export search results

    The export option will allow you to export the current search results of the entered query to a file. Different formats are available for download. To export the items, click on the button corresponding with the preferred download format.

    By default, clicking on the export buttons will result in a download of the allowed maximum amount of items.

    To select a subset of the search results, click "Selective Export" button and make a selection of the items you want to export. The amount of items that can be exported at once is similarly restricted as the full export.

    After making a selection, click one of the export format buttons. The amount of items that will be exported is indicated in the bubble next to export format.