Rochester Studies Nursing Home Quality Locally, Statewide

October 05, 2005

A $1.28 million grant was awarded to the University of Rochester Medical Center to research how to improve nursing home quality and patient care through better employee teamwork and management practices.

The National Institutes of Health funded the four-year project, which involves surveying as many as 18,000 nursing home employees in New York State. Most prior studies have tried to explain differences in quality of care by assessing the impact of nursing home size, profit status and staffing levels on patient outcomes.

But the UR group plans to take a different approach. Since nursing homes are known as “low-tech, high-touch” environments, the researchers will test the relationship between how the organization performs – for example, the way staff interacts – and patient outcomes. (Outcomes are measured by factors such as the frequency of bedsores, urinary incontinence and a rapid loss of functioning.) The study will evaluate leadership, communication skills, coordination of care, conflict resolution and team performance within 375 randomly selected nursing homes.

“We all believe in the team process and we say that teams are good, but in long-term care settings we have no proof that better-performing teams produce better patient care outcomes,” said Helena Temkin-Greener, Ph.D., MPH, an expert on elder care and a national authority on how to develop and evaluate programs that serve the elderly. “If we can document that teamwork is valuable, then we may be able to create relatively inexpensive quality improvements.”

The number of people needing nursing homes is expected to rise with aging baby boomers. Currently about 100,000 patients reside in 666 nursing homes in the state and 34 homes in Monroe County. Nationally, about seven million older Americans needed long-term care in 2002 with a projected increase to 12 million people by 2020, according to the Health Insurance Association of America.

Against that backdrop, Temkin-Greener said, it is vital to study how to improve nursing home operations. The project begins this month with an invitation that encourages nursing homes to participate in various surveys. Employees will be asked things such as, “How much flexibility do you have in decision-making?” And they will have the chance to disclose whether “it’s easy to talk to managers” about problems.

Most nursing homes experience high costs due to high turnover and constant rehiring and training. An objective of the study is to provide managers and owners with new strategies to improve the work environment and staff retention, Temkin-Greener said.

Furthermore, nursing homes are often rated on quality of care using data that are not “risk adjusted,” meaning that some quality reviews make apples-to-oranges comparisons because they don’t account for differences in illness levels among patient populations. The UR study will control for patient characteristics, which should give a more accurate picture of quality of care, said Temkin-Greener, a research associate professor, Division of Health Services Research, UR Department of Community & Preventive Medicine.

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