SQUID
Development of Nursing Home Staffing Quality Measures for Public Reporting
Funded by: Centers for Medicare & Medicaid Services
Project Period: 10/03 - 3/05
Abstract
Objectives: Serious problems with nursing home patient care have
been attributed in part to inadequate staffing, particularly nursing staff. Studies have
demonstrated strong relationships between characteristics of nursing home staffing (e.g.,
RN hours per patient per day and nursing staff turnover rates) and outcomes such as
hospitalization and morbidity. As a result, the Institute of Medicine and Congress have
called for public reporting of information on staffing in nursing homes. The purpose of
this study is to identify the best staffing measures and the best data sources for those
measures to be used for public reporting. Ultimately, this information will be posted on
a public Web site to be used by individuals selecting a nursing home in which to place a
family member.
Methods: The project began with a thorough review of relevant
literature to identify what is already known about facility staffing measures.
Subsequently, meetings with technical experts and members of the interested public were
held to provide discussion and advice on the best measures to use for public reporting of
nursing home quality. Appropriate data sources were identified with which to calculate the
preferred staffing quality measures. The statistical properties of the different measures
will be explored and compared. Lastly, a later phase of the project will use Medicare data
files to calculate patient outcomes and compare them to our new measures of nursing home
staffing quality.
Results: The expert panel and stakeholders
recommended we focus on measures of staffing levels such as RN hours per patient day,
total nursing hours per patient day, and total staff hours (for all types of staff) per
patient day. Additionally, there was a high level of interest in measures of staff
turnover and retention for RNs and for total nursing staff. We were further advised that
the data files that currently capture some of this information are not accurate or reliable
and that a better data source should be used, namely the nursing homes’ existing payroll
data files. We requested payroll data files from 10 large nursing home corporations; seven
corporations agreed to provide these data for 1174 individual facilities.
Discussion: Valid, reliable information regarding the quality of
nursing home staffing is sorely needed. Although the relationship between nursing staffing
levels and quality of care has been demonstrated in nursing homes, further study is required
to determine the best measures of staffing quality for public reporting and to identify
optimal data sources from which to calculate these measures. Information regarding nursing
home staff quality can then be made available to the public to help inform their
decision-making process when selecting a nursing home. The government already provides a
nursing home quality comparison Web site (www.medicare.gov/nhcompare) to which this
information will be added.
Key Staff: Kramer, Palmer. Donelan-McCall, Eilertsen, Hurd, Rantz, Mattivi, Regensburger,
Romaglia
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