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Nicholas G. Castle - One of the best experts on this subject based on the ideXlab platform.
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Characteristics of Nursing Homes that close.
Health Care Management Review, 2020Co-Authors: Nicholas G. CastleAbstract:: This study examined closures in the Nursing home industry from 1992 to 1998. Data used in this investigation primarily came from the Online Survey Certification and Recording (OSCAR) system, representing 13,212 Nursing Homes. Descriptive analysis showed 607 Nursing Homes closed during this time. Our results are important. On the one hand, the results show that Nursing Homes are sensitive to their operating environment; on the other hand, the likelihood of closure is very small, representing less than 1 percent of facilities per year.
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top management turnover and quality in Nursing Homes
Health Care Management Review, 2010Co-Authors: Nicholas G. CastleAbstract:Background: Understanding the relationship between top management turnover and quality of care is important because turnover among top managers in Nursing Homes is generally high. Purposes: In this research, the direct and indirect relationships among top management turnover, the number of staff, the types of staff, and the quality indicators are examined. The top managers included in this case are both Nursing home administrators and directors of Nursing. Methodology/Approach: Primary data were collected from 2,840 Nursing Homes, and 14 quality indicators came from the Nursing Home Compare. Structural equation modeling methods were used to model direct and indirect relationships. Findings: The results show that high Nursing home administrator turnover for four quality indicators are significantly associated with poor quality. These findings seem to contrast with those for director of Nursing turnover, with high director of Nursing turnover for three quality indicators significantly associated with better quality. Practice Implications: We identify three practice implications. First, Nursing home administrators may want to be particularly vigilant to resident care in some specific areas associated with poorer quality resulting from turnover. Second, nurse aide agency staff should be used with caution. Third, higher caregiver staffing levels are generally associated with better quality of care.
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the influence of staffing characteristics on quality of care in Nursing Homes
Health Services Research, 2007Co-Authors: Nicholas G. Castle, John EngbergAbstract:Objective. The influence staffing levels, turnover, worker stability, and agency staff had on quality of care in Nursing Homes was examined. Data Sources/Study Setting. Staffing characteristics came from a survey of Nursing Homes (N=1,071) conducted in 2003. The staffing characteristics were collected for Nurse Aides, Licensed Practical Nurses, and Registered Nurses. Fourteen quality indicators came from the Nursing Home Compare website report card and Nursing home organizational characteristics came from the Online Survey, Certification, and Recording system. Study Design. One index of quality (the outcome) was created by combining the 14 quality indicators using exploratory factor analysis. We used regression analyses to assess the effect of the four staffing characteristics for each of the three types of Nursing staff on this quality index in addition to individual analyses for each of the 14 quality indicators. The effect of organizational characteristics as well as the markets in which they operated on outcomes was examined. We examined a number of different model specifications. Principal Findings. Quality of care was influenced, to some degree, by all of these staffing characteristics. However, the estimated interaction effects indicated that achieving higher quality was dependent on having more than one favorable staffing characteristic—the effect of quality was larger than the sum of the independent effects of each favorable staffing characteristic. Conclusions. Our results indicate that staff characteristics such as turnover, staffing levels, worker stability, and agency staff should be addressed simultaneously to improve the quality of Nursing Homes.
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Nursing home administrators' opinions of the resident safety culture in Nursing Homes.
Health Care Management Review, 2007Co-Authors: Nicholas G. Castle, Steven M. Handler, John Engberg, K E SononAbstract:BACKGROUND: In recent years, we have seen substantial interest in patient safety initiatives in health care. However, most studies in this area have examined hospital settings; few studies have examined Nursing Homes. PURPOSES: First, the resident safety culture of Nursing Homes from a top management perspective is compared with existing data from hospitals. Second, how the safety culture of Nursing Homes varies according to facility characteristics and market characteristics is examined. METHODOLOGY/APPROACH: Data came from a nationally representative sample of Nursing Homes (N = 2,840 completed surveys and a response rate of 71%). Administrators of these Nursing Homes completed The Hospital Survey on Patient Safety Culture (HSOPSC) instrument, a previously validated survey with 12 subscales used to assess safety culture. The Nursing home scores from this instrument were compared with the hospital scores. Multivariate regression was used to examine the association between nine Nursing home facility characteristics and three market characteristics and each of the subscales. FINDINGS: Nine of the ten HSOPSC subscale scores from the Nursing home sample were considerably lower than the hospital scores, indicating a less well-developed safety culture. The significant facility and market characteristics from the regression analyses resemble many of those found when the same characteristics are used in examinations of quality. PRACTICE IMPLICATIONS: We have witnessed many patient safety initiatives in hospitals. These may be a harbinger of things to come for Nursing Homes. Thus, we argue that Nursing Homes in the near future would benefit by addressing the resident safety culture. This may also have the beneficial effect of improving the image of the industry.
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A culture of patient safety in Nursing Homes
Quality & Safety in Health Care, 2006Co-Authors: Nicholas G. Castle, K E SononAbstract:Background: Few accounts of patient safety initiatives in Nursing Homes exist. Objective: To (1) determine safety culture scores for Nursing Homes and (2) compare these results with existing data from hospitals. Methods: Data were collected from a nationally representative sample of Nursing Homes (n = 2840 completed surveys and a response rate of 71%). From these Nursing Homes, administrators completed The Hospital Survey On Patient Safety Culture (HSOPSC) instrument. Results: 11 of the 12 HSOPSC subscale scores from the Nursing home sample were considerably lower than the benchmark hospital scores. In addition, almost all item scores from Nursing Homes were considerably lower than the benchmark hospital scores. These results indicate that a less well-developed safety culture exists in Nursing Homes. Conclusions: The results clearly show that the patient safety culture scores of Nursing Homes are considerably lower than those of hospitals. Residents of Nursing Homes may be at risk of harm as a result of patient safety errors.
John Engberg - One of the best experts on this subject based on the ideXlab platform.
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the influence of staffing characteristics on quality of care in Nursing Homes
Health Services Research, 2007Co-Authors: Nicholas G. Castle, John EngbergAbstract:Objective. The influence staffing levels, turnover, worker stability, and agency staff had on quality of care in Nursing Homes was examined. Data Sources/Study Setting. Staffing characteristics came from a survey of Nursing Homes (N=1,071) conducted in 2003. The staffing characteristics were collected for Nurse Aides, Licensed Practical Nurses, and Registered Nurses. Fourteen quality indicators came from the Nursing Home Compare website report card and Nursing home organizational characteristics came from the Online Survey, Certification, and Recording system. Study Design. One index of quality (the outcome) was created by combining the 14 quality indicators using exploratory factor analysis. We used regression analyses to assess the effect of the four staffing characteristics for each of the three types of Nursing staff on this quality index in addition to individual analyses for each of the 14 quality indicators. The effect of organizational characteristics as well as the markets in which they operated on outcomes was examined. We examined a number of different model specifications. Principal Findings. Quality of care was influenced, to some degree, by all of these staffing characteristics. However, the estimated interaction effects indicated that achieving higher quality was dependent on having more than one favorable staffing characteristic—the effect of quality was larger than the sum of the independent effects of each favorable staffing characteristic. Conclusions. Our results indicate that staff characteristics such as turnover, staffing levels, worker stability, and agency staff should be addressed simultaneously to improve the quality of Nursing Homes.
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Nursing home administrators' opinions of the resident safety culture in Nursing Homes.
Health Care Management Review, 2007Co-Authors: Nicholas G. Castle, Steven M. Handler, John Engberg, K E SononAbstract:BACKGROUND: In recent years, we have seen substantial interest in patient safety initiatives in health care. However, most studies in this area have examined hospital settings; few studies have examined Nursing Homes. PURPOSES: First, the resident safety culture of Nursing Homes from a top management perspective is compared with existing data from hospitals. Second, how the safety culture of Nursing Homes varies according to facility characteristics and market characteristics is examined. METHODOLOGY/APPROACH: Data came from a nationally representative sample of Nursing Homes (N = 2,840 completed surveys and a response rate of 71%). Administrators of these Nursing Homes completed The Hospital Survey on Patient Safety Culture (HSOPSC) instrument, a previously validated survey with 12 subscales used to assess safety culture. The Nursing home scores from this instrument were compared with the hospital scores. Multivariate regression was used to examine the association between nine Nursing home facility characteristics and three market characteristics and each of the subscales. FINDINGS: Nine of the ten HSOPSC subscale scores from the Nursing home sample were considerably lower than the hospital scores, indicating a less well-developed safety culture. The significant facility and market characteristics from the regression analyses resemble many of those found when the same characteristics are used in examinations of quality. PRACTICE IMPLICATIONS: We have witnessed many patient safety initiatives in hospitals. These may be a harbinger of things to come for Nursing Homes. Thus, we argue that Nursing Homes in the near future would benefit by addressing the resident safety culture. This may also have the beneficial effect of improving the image of the industry.
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organizational characteristics associated with staff turnover in Nursing Homes
Gerontologist, 2006Co-Authors: Nicholas G. Castle, John EngbergAbstract:Purpose: The association between certified nurse aide, licensed practical nurse, and registered nurse turnover and the organizational characteristics of Nursing Homes are examined. Design and Methods: Hypotheses for eight organizational characteristics are examined (staffing levels, top management turnover, resident case mix, facility quality, ownership, chain membership, size, and Medicaid census), using Online Survey, Certification, and Reporting (known as OSCAR) data. Turnover information came from primary data collected from 854 facilities in six states (Missouri, Texas, Connecticut, New York, Pennsylvania, and New Jersey). Results: The 1-year turnover rates were 56.4%, 39.7%, and 35.8% for certified nurse aides, licensed practical nurses, and registered nurses, respectively. The results consistently show that, for all caregivers, lower staffing levels, lower quality, for-profit ownership, and higher bed size are associated with higher turnover. Some differences also are found for different levels of turnover, but there are few differences among types of Nursing staff. Implications: Given that turnover rates are problematic, this study gives us a better understanding of the phenomenon and at the same time helps us further understand the wide variation that is known to exist between Nursing Homes, based on their organizational characteristics.
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staff turnover and quality of care in Nursing Homes
Medical Care, 2005Co-Authors: Nicholas G. Castle, John EngbergAbstract:Purpose:In this work, the association between nurse aide (NA) plus licensed practical nurse (LPN) and registered nurse (RN) turnover and quality indicators in Nursing Homes is examined.Design and Methods:Indicators of care quality used are the rates of physical restraint use, catheter use, contractu
M M Tunney - One of the best experts on this subject based on the ideXlab platform.
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antimicrobial prescribing in european Nursing Homes
Journal of Antimicrobial Chemotherapy, 2011Co-Authors: Pamela Mcclean, Carmel Hughes, M M Tunney, Herman Goossens, B. JansAbstract:Results: A total of 10 388 and 9430 residents participated in April and November 2009, respectively. The mean prevalence of antimicrobial prescribing in the Nursing Homes was 6.5% in April and 5.0% in November. The most commonly prescribed antimicrobials were methenamine (17.5%), trimethoprim (11.4%) and co-amoxiclav (11.1%) in April and co-amoxiclav (12.2%), nitrofurantoin (12.2%) and methenamine (11.5%) in November. There was large variation in the overall mean antimicrobial prescribing in the selected Nursing Homes from each of the contributing countries, ranging from 1.4% in Germany and Latvia to 19.4% in Northern Ireland in April and 1.2% in Latvia to 13.4% in Finland in November. Furthermore, differences in prescribing were apparent within countries with the largest variation evident in Nursing Homes in Northern Ireland (21.5%) in April and Finland in November (30.1%). Conclusions: This is the first study to investigate antimicrobial prescribing in Nursing Homes in a large number of European countries. The findings suggest that there is considerable variation in antimicrobial prescribing in Nursing Homes across and within European countries. Nursing Homes provide a significant service to the European community and must be supported in order to optimize antimicrobial use and limit the development of antimicrobial resistance.
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prevalence of methicillin resistant staphylococcus aureus colonization in residents and staff in Nursing Homes in northern ireland
Journal of the American Geriatrics Society, 2009Co-Authors: Naomi S Baldwin, D F Gilpin, Carmel M Hughes, M P Kearney, Ann D Gardiner, Christopher Cardwell, M M TunneyAbstract:OBJECTIVES: To determine the prevalence of, and factors associated with, methicillin-resistant Staphylococcus aureus (MRSA) colonization in residents and staff in Nursing Homes in one geographically defined health administration area of Northern Ireland. DESIGN: Point prevalence study. SETTING: Nursing Homes. PARTICIPANTS: Residents and staff in Nursing Homes. MEASUREMENTS: Nasal swabs were taken from all consenting residents and staff. If relevant, residents also provided urine samples, and swabs were taken from wounds and indwelling devices. RESULTS: A total of 1,111 residents (66% of all residents) and 553 staff (86% of available staff) in 45 Nursing Homes participated. The combined prevalence rate of MRSA in the resident population was 23.3% (95% confidence interval (CI)=18.8-27.7%) and 7.5% in staff (95% CI=5.1-9.9%). Residents who lived in Nursing Homes that were part of a chain were more likely to be colonized with MRSA (odds ratio (OR)=1.91, 95% CI=1.21-3.02) than those living in independently owned facilities. Residents were also more likely to be colonized if they lived in Homes in which more than 12.5% of all screened healthcare staff (care assistants and nurses) were colonized with MRSA (OR=2.46, 95% CI=1.41-4.29) or if they lived in Homes in which more than 15% of care assistants were colonized with MRSA (OR=2.64, 95% CI=1.58-4.42). CONCLUSION: The findings suggest that there is substantial colonization of MRSA in Nursing home residents and staff in this one administrative health area. Implementation of infection control strategies should be given high priority in Nursing Homes.
Susan S Huang - One of the best experts on this subject based on the ideXlab platform.
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Methicillin-resistant Staphylococcus aureus burden in Nursing Homes associated with environmental contamination of common areas
Journal of the American Geriatrics Society, 2012Co-Authors: Courtney Reynolds Murphy, Samantha J. Eells, Victor Quan, Diane Kim, Ellena Peterson, Loren G Miller, Susan S HuangAbstract:OBJECTIVES: To determine whether environmental cleaning and contamination are associated with variation in the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) between Nursing Homes.\n\nDESIGN: Prospective study of environmental contamination and cleaning quality.\n\nSETTING: Nursing home.\n\nPARTICIPANTS: Ten California Nursing Homes.\n\nMEASUREMENTS: Nursing Homes were categorized into two groups based upon high and low differences in MRSA point prevalence and admission prevalence (delta prevalence) from nares screenings of Nursing home residents. Environmental cleaning and infection control practices were evaluated by culturing common area objects for MRSA, assessing removal of intentionally applied marks visible only under ultraviolet (UV) light, and administering surveys on infection control and cleaning.\n\nRESULTS: Overall, 16% (78/500) of objects were MRSA positive, and 22% (129/577) of UV-visible marks were removed. A higher proportion of MRSA-positive objects was found in the high (19%) than in low (10%) Nursing home groups (P = .005). Infection control and cleaning policies varied, including the frequency of common room cleaning (median 2.5 times daily, range 1-3 times daily) and time spent cleaning per room (median 18 minutes, range 7-45 minutes). In multivariate models, MRSA-positive objects were associated with high delta prevalence Nursing Homes (odds ratio (OR) = 2.8, P = .005), less time spent cleaning each room (OR = 2.9, P < .001), and less-frequent cleaning of common rooms (OR = 1.5, P = .01).\n\nCONCLUSION: Substantial variation was found in MRSA environmental contamination, infection control practices, and cleaning quality. MRSA environmental contamination was associated with greater differences between MRSA point and admission prevalence, less-frequent common room cleaning, and less time spent cleaning per room, which suggests that modifying cleaning practices may reduce MRSA environmental contamination and burden in Nursing Homes.
Jean Moore - One of the best experts on this subject based on the ideXlab platform.
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a statewide assessment of electronic health record adoption and health information exchange among Nursing Homes
Health Services Research, 2014Co-Authors: Erika L Abramson, Jean Moore, Sandra Mcginnis, Rainu KaushalAbstract:Objective To determine rates of electronic health record (EHR) adoption and health information exchange (HIE) among New York State (NYS) Nursing Homes.
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A statewide assessment of electronic health record adoption and health information exchange among Nursing Homes
Health Services Research, 2014Co-Authors: Erika L Abramson, Jean Moore, Shannon Mcginnis, Robin KaushalAbstract:OBJECTIVE: To determine rates of electronic health record (EHR) adoption and health information exchange (HIE) among New York State (NYS) Nursing Homes.\n\nDATA SOURCES/STUDY SETTING: Primary data collected from a novel survey administered between November 2011 and March 2012 to all NYS Nursing Homes.\n\nSTUDY DESIGN: We used a cross-sectional study design to assess level of EHR implementation, automation of key functionalities, participation in HIE, and barriers to adoption.\n\nDATA COLLECTION/EXTRACTION METHODS: We used descriptive statistics to characterize rates of EHR adoption and participation in HIE and logistic regression to identify Nursing home characteristics associated with EHR adoption and HIE.\n\nPRINCIPAL FINDINGS: We received responses from 375 of 632 Nursing Homes (59.3 percent). Of respondents, almost one in five (n=66, 18.0 percent) reported having a fully implemented and operational EHR and a majority (n=192, 54.4 percent) reported electronically exchanging information. Nursing Homes with 100-159 beds were significantly less likely than other facilities to have implemented or be in the process of implementing an EHR (p=.011).\n\nCONCLUSIONS: Our findings present an important systematic look at EHR adoption and HIE by NYS Nursing Homes. Although the Nursing home sector has been reported to lag in health information technology adoption, our results are encouraging. However, they suggest much room for growth and highlight the need for targeted initiatives to achieve more widespread adoption in this important health care sector.
