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Measuring the quality of care for older people
- Authors:
- POTTER Jonathan, GEORGIOU Andrew, PEARSON Michael
- Publisher:
- Royal College of Physicians
- Publication year:
- 2000
- Pagination:
- 136p.,tables,diags.,bibliogs.
- Place of publication:
- London
Examines how to measure standards in health care for older people. Begins with a discussion of techniques for measuring quality. Moves on to discuss the national agenda for quality, with reference to the National Service Framework and the National Institute for Clinical Excellence. Then examines care studies of specific areas of health care, including stroke and incontinence, with critiques of their methodology. Concludes with recommendations for future practice.
Quality of care reported by proxies – does resident cognition count?
- Authors:
- KAHANPAA Anja, NORO Anja, PERALA Marja-Leena
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 18(7-8), 2019, pp.2543-2555.
- Publisher:
- Sage
Resident self-reports are considered the primary source of quality of care information, but proxy reports by family or staff can also be used to supplement or substitute resident reports. This study analyses how the results of proxy reports vary according to residents’ cognition level. The data set used covers proxy reports of family (n = 558) and staff (n = 801), divided by the availability of resident self-reports (family yes n = 289, no n = 269; staff yes 393, no = 408). Family and staff proxies assessed residents’ quality of care as better when resident self-reports were also available, and quality of care tended to be assessed as poorer among those with higher cognitive decline. The results of this methodological study indicate the importance of using several proxy evaluations; however, these can only supplement resident self-reports, not replace them. The interpretation rules acknowledging dependency between residents’ cognition and proxy assessments could be used as a basis for future comparisons of quality improvement in long-term care and for painting a more comprehensive picture of service quality. (Edited publisher abstract)
Continuous quality improvement as an innovation: which nursing facilities adopt it?
- Authors:
- LUCAS Judith A., et al
- Journal article citation:
- Gerontologist, 45(1), February 2005, pp.68-77.
- Publisher:
- Oxford University Press
The authors identify environmental and organizational predictors that best discriminate between formal continuous quality improvement (CQI) adopters and nonadopters in nursing homes (NHs) and create a diagnostic profile for facility administrators and policy makers to promote CQI. The authors performed a cross-sectional survey of licensed NH administrators in New Jersey in 1999, using The Nursing Care Quality Improvement Survey and The New Jersey NH Profiles Chart. Of 350 NHs, 46% returned completed questionnaires. Using variance innovation, resource dependence, and institutional perspectives, the authors found that new requirements, environmental competition, organizational time and structural facilitators, and manager training made statistically significant contributions to discriminating between formal CQI adopters and nonadopters. Regardless of size, NHs adopt formal CQI to meet external expectations of new regulations and accreditation criteria. CQI adoption is facilitated by information systems, flexible use of personnel, and team supports, as well as CQI training for managers. This profile of adopters can guide administrators and policy makers in promoting CQI for NHs, and it can help NHs already interested in CQI focus internal resources on key facilitators.
Developing a satisfaction survey for families of Ohio's nursing home residents
- Authors:
- EJAZ Farida, et al
- Journal article citation:
- Gerontologist, 43(4), August 2003, pp.447-458.
- Publisher:
- Oxford University Press
The purpose of this project was to develop a reliable and valid family satisfaction instrument for use in Ohio's nursing homes. Investigators worked with an advisory council to develop the survey. Purposive sampling techniques were largely used to select 12 small, medium, and large for-profit and proprietary facilities in one large county for the pretest. A total of 239 families who were "most involved" in their relative's care completed an instrument with 97 satisfaction items. Results: Factor analyses identified nine factors that explained 59.44% of the variance in satisfaction. Investigator judgment modified some factors and developed scales. The scales had good internal reliability ( and above, except for one), test–retest reliability ranged from.49 to.88, and differences between families of short- and long-stay residents were in expected directions. A final instrument with 62 satisfaction and 17 background items was recommended for statewide implementation. : Findings from the project can be used to further refine the instrument and protocols for use with larger populations in other states and by the federal government.
Factors influencing residents' satisfaction in residential aged care
- Authors:
- CHOU Shu-Chiung, BOLDY Duncan P., LEE Andy H.
- Journal article citation:
- Gerontologist, 43(4), August 2003, pp.459-472.
- Publisher:
- Oxford University Press
The aim of this study was to identify the important factors influencing residents' satisfaction in residential aged care and to provide a better understanding of their interrelationships. A cross-sectional survey design was used to collect the required information, including resident satisfaction, resident dependency levels, and staff satisfaction. A stratified random sampling approach was utilized to select facilities. All residents satisfying the selection criteria (i.e., understand English, be sufficient cognitive competence, have a sufficient energy level to participate in the survey, and live in the facility for more than 4 weeks) and all care staff were invited to participate. A total of 996 residents and 895 staff from 62 facilities (36 hostels and 26 nursing homes) provided the required data. Structural equation modeling was used to examine the interrelationships among three sets of contributing factors, related to the facility, staff and residents, and resident satisfaction components, separately for nursing home and hostel residents. Overall fits of both nursing home and hostel models were satisfactory. This study has revealed that staff satisfaction plays a crucial and central role in determining resident satisfaction in nursing homes, whereas it has less impact in hostels. The provision of more care hours has only a small, yet positive, impact on resident satisfaction. Larger facility size has a negative impact on resident involvement. Older residents were found to be more satisfied with staff care. The results provide a comprehensive understanding of what influences resident satisfaction. By accounting for important factors identified by residents, a resident-focused care model can be developed and implemented, leading to better service for aged care residents.
Obstacles to implementing research outcomes in community settings
- Authors:
- BALL Karlene, WADLEY Virginia, ROENKER Daniel
- Journal article citation:
- Gerontologist, 43(Special Issue), March 2003, pp.29-36.
- Publisher:
- Oxford University Press
This American article argues that in contrast to controlled laboratory or clinic-based research that can fail to capture the real-world behaviors of older adults, field research offers the best opportunity for ecological validity. However, the tradeoff inherent in field studies is the potential sacrifice of scientific rigour. Applied research presents a unique set of challenges that vary with context. This article discusses these challenges along with possible solutions. Examples are drawn from an ongoing, longitudinal study of driving competence that is being conducted in Department of Motor Vehicles field sites. The challenges faced at each stage of the project are discussed. Methodological issues include identifying field collaborators, approaching administrators with the research proposal, producing a battery that is manageable and acceptable while maintaining scientific merit, training indigenous personnel to administer this battery, introducing the research and consenting potential participants, and managing large data sets offsite. Additional issues include quality control, the importance of distinguishing between individuals who consent and those who decline participation, and the collection of follow-up data via telephone.
Practically relevant research: capturing real world tasks, environments, and outcomes
- Authors:
- CZAJA Sara J., SHARIT Joseph
- Journal article citation:
- Gerontologist, 43(Special Issue), March 2003, pp.9-18.
- Publisher:
- Oxford University Press
Development of strategies to optimise the functional performance of older adults requires understanding the behaviour of older people doing tasks in real-world settings and capturing these interactions in research protocols. This is a major challenge as there is some degree of tension between capturing the contextual variables and constraints that operate in the real world and the scale of research that can be realistically conducted within controlled experimental settings. This article presents a research approach that can be used to help ensure the ecological validity of research protocols. The intent is to demonstrate how an ecologically valid approach affords greater insight into the performance of older adults in real world settings. The approach involves techniques such as task analysis and simulation. Examples from two research projects examining aging and the performance of real-world computer-based work tasks are used to demonstrate the application of this approach. The article demonstrates how an ecologically valid research approach yields information about human performance that can be translated into solutions for real-world problems.
Sheltered housing tenant satisfaction
- Authors:
- FOORD Mark, SODHI Dianne, SAVORY Julie
- Journal article citation:
- Working with Older People, 6(4), December 2002, pp.31-35.
- Publisher:
- Emerald
Reports on a project to develop a tenant satisfaction measurement instrument for sheltered housing tenants. The article examines the issues involved in developing ways to measure tenant satisfaction; draws on data collected from residents during the course of the research; and sets out the research results.
Quality issues in discharge from hospital - the views of older people and their carers
- Authors:
- POWELL Jackie, LOVELOCK Robin, BRAY Jane, PHILIP Ian
- Journal article citation:
- Social Services Research, 1 1994, 1994, pp.42-55.
- Publisher:
- Social Services Research Group
The article is based upon a qualitative study which gained the views of patients and carers on the quality of in-patient care and discharge arrangements on and Elderly Care Unit in a large general hospital in Southampton. The methodology used is discussed in some detail and is followed by presentation and discussion of the findings on the selected topics of: discharge to home or to a carer's home, and discharge to residential care.
Providing outcomes information to nursing homes: can it improve quality of care?
- Author:
- CASTLE Nicholas G.
- Journal article citation:
- Gerontologist, 43(4), August 2003, pp.483-492.
- Publisher:
- Oxford University Press
This study examined whether providing outcomes information to 120 nursing homes facilitated improvements in quality over a 12-month period, as compared with 1,171 facilities not receiving this information. The outcomes information provided consisted of a report mailed to administrators that examined six measures of care quality. These were the rates of physical restraint use, urethral catheterization, contractures, pressure ulcers, psychotropic medication use, and certification survey quality of care deficiencies. Data used in this investigation came from the 1998 and 1999 On-line Survey, Certification and Recording (OSCAR) system. With the use of generalized least squares regression and each of the six quality indicators as dependent variables, risk-adjustment models were developed by using aggregate resident variables as independent variables. These risk-adjustment models were used to compare the outcome measures for the intervention facilities with the same outcome measures in other facilities in the same states (Kansas, Maine, Mississippi, New York, Texas, and South Dakota). The difference between 1998 predicted scores less actual scores was calculated, and the difference between 1999 predicted scores less actual scores for each facility was calculated. Subtracting these 1998 difference scores from the 1999 difference scores gives some indication of the change in outcomes controlling for resident mix. Results: Physical restraint use and psychotropic medication use were significantly lower after 12 months in the intervention facilities, suggesting that quality had improved. This study may provide evidence that some of the outcomes initiatives currently being pursued in the long-term care arena will positively affect quality of care.