Health Care Administration and Organization

Collection of articles on Health Care Administration and Organization is available here.

Healthcare Professionals’ Perspective on Implementing a Detector of Behavioural Disturbances in Long-Term Care Homes
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Choukou MA, Mbabaali S, East R.
Int J Environ Res Public Health 2021 Mar 8;18(5):2720. doi: 10.3390/ijerph18052720.”
The number of Canadians with dementia is expected to rise to 674,000 in the years to come. Finding ways to monitor behavioural disturbance in patients with dementia (PwDs) is crucial. PwDs can unintentionally behave in ways that are harmful to them and the people around them, such as other residents or care providers. Current practice does not involve technology to monitor PwD behaviours. Events are reported randomly by nonstaff members or when a staff member notices the absence of a PwD from a scheduled event. This study aims to explore the potential of implementing a novel detector of behavioural disturbances (DBD) in long-term care homes by mapping the perceptions of healthcare professionals and family members about this technology. Qualitative information was gathered from a focus group involving eight healthcare professionals working in a tertiary care facility and a partner of a resident admitted in the same facility. Thematic analysis resulted in three themes: (A) the ability of the DBD to detect relevant dementia-related behavioural disturbances that are typical of PwD; (B) the characteristics of the DBD and clinical needs and preferences; (C) the integration of the DBD into daily routines. The results tend to confirm the adequacy of the DBD to the day-to-day needs for the detection of behavioural disturbances and hazardous behaviours. The DBD was considered to be useful and easy to use in the tertiary care facility examined in this study. The participants intend to use the DBD in the future, which means that it has a high degree of acceptance.

Predicting Nursing Home Financial Distress Using the Altman Z-Score
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Lord J, Landry A, Savage GT, Weech-Maldonado R.
Inquiry 2020 Jan-Dec;57:46958020934946.
This article uses a modified Altman Z-score to predict financial distress within the nursing home industry. The modified Altman Z-score model uses multiple discriminant analysis (MDA) to examine multiple financial ratios simultaneously to assess a firm’s financial distress. This study utilized data from Medicare Cost Reports, LTCFocus, and the Area Resource File. Our sample consisted of 167 268 nursing home-year observations, or an average of 10 454 facilities per year, in the United States from 2000 through 2015. The independent financial variables, liquidity, profitability, efficiency, and net worth were entered stepwise into the MDA model. All of the financial variables, with the exception of net worth, significantly contributed to the discriminating power of the model. K-means clustering was used to classify the latent variable into 3 categorical groups: distressed, risk-of-financial distress, and healthy. These findings will provide policy makers and practitioners another tool to identify nursing homes that are at risk of financial distress.

Improvement in palliative care quality in rural nursing homes through information and communication technology-driven interprofessional collaboration
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Ohta R, Ryu Y.
Rural Remote Health 2021 Apr;21(2):6450.
INTRODUCTION: Information and communication technology (ICT) can facilitate long-term care. In long-term care, effective communication among healthcare professionals is vital to reduce inappropriate emergency transfer and eventual death in hospitals. As nursing homes in rural areas lack adequate healthcare resources, ICT can reduce the burden on professionals, leading to adequate long-term care. This study investigated whether the application of ICT-based communication can reduce the number of emergency transportations to, and death in, hospitals in rural facilities. METHODS: This was an interventional study. Participants were patients living in a rural nursing home in the westernmost part of Unnan City in Shimane prefecture, Japan. The intervention group was defined as patients living therein after application of the ICT system and the control group as patients living therein before application of the ICT system. The primary outcome was the rate of emergency transportation to hospitals and the secondary outcome was the rate of death in the nursing home. RESULTS: The total number of participants was 96 (48 in the ICT usage group and 48 in the control group), and the average age of this sample was 89.5 years. The rate of emergency transportation was 54.2% (26/48) in the control group and 29.2% (14/48) in the intervention group (p=0.022). The rate of end-of-life care in the nursing home was 33.3% (3/9) in the control group and 84.6% (11/13) in the intervention group (p<0.001). CONCLUSION: ICT-driven nursing home care can reduce emergency transportation from nursing homes and enable patients in nursing homes to remain there longer, leading to an increase in end-of-life care in nursing homes, which provides hope to patients and their families. Therefore, these findings highlight that the continuous provision of ICT can facilitate end-of-life care in nursing homes.

An exploration of the link between residents’ demands and caregivers’ well-being: Evidence from the long-term healthcare industry
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Sebastiano A, Giangreco A, Peccei R.
Health Serv Manage Res 2021 Apr 11:951484821994427.
This study examines the extent to which important personal characteristics of nursing home residents affect the well-being of caregivers, as reflected in their levels of work-related positive and negative affect. To do this, we applied the Job Demands-Resources model to the analysis of caregivers’ work-related well-being by focusing on residents’ residual cognitive capacity and their perceived adequacy of resources. A multiple regression analysis was carried out based on combined data from a sample of 1080 caregivers and 290 residents from 13 nursing homes in Italy. Predictors of caregivers’ positive and negative well-being included job characteristics such as workload and social support. As expected, residents’ perceived adequacy of resources was positively related to caregivers’ well-being positive affect. Unexpectedly, residents’ residual cognitive capacity was associated with higher rather than lower levels of caregivers’ well-being negative affect. The quality of the interaction between residents and caregivers in nursing homes is contingent on their respective expectations and capabilities, and reciprocal perceptions of the outputs exchanged.

Nursing Home Staff Turnover and Perceived Patient Safety Culture: Results from a National Survey
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Temkin-Greener H, Cen X, Li Y.
Gerontologist 2020 Sep 15;60(7):1303-1311.
BACKGROUND AND OBJECTIVES: We examined the association between turnover of registered nurses (RNs) and certified nurse assistants (CNAs) and perceived patient safety culture (PSC) in nursing homes (NHs). RESEARCH DESIGN AND METHODS: In 2017, we conducted PSC survey using the Agency for Healthcare Research and Quality- developed and -validated instrument for NHs. A random sample of 2,254 U.S. NHs was identified. Administrators, directors of nursing (DONs), and nurse unit leaders served as respondents. Responses were obtained for 818 facilities from 1,447 individuals. The instrument contained 42 items relating to 12 PSC domains and turnover rates. PSC domains were based on five-point Likert scale items. A positive response was defined as “agree” or “strongly agree” (4-5 on the Likert scale). For CNAs low turnover was defined as <35%, and for RNs <15%. Facility-level and market-competition characteristics were included. Bivariate comparisons employed analysis of variance and chi-square tests. In multivariable models, we fit separate linear regressions for the average positive PSC score and for each of the 12 PSC domains, including turnover rates, NH, and market factors. RESULTS: In NHs with low turnover, the overall PSC scores were 4.04% (RNs) and 6.28% (CNAs) higher than in NHs with high turnover. Teamwork, staffing, and training/skills were associated with CNA but not RN turnover. DISCUSSION AND IMPLICATIONS: The effect of turnover on PSC depends on who leaves and to a lesser extent on the organizational characteristics. In NHs, improvements in PSC may depend on the ability to retain a well-trained and skilled nursing staff.

Nursing Home Competition, Prices and Quality: A Scoping Review and Policy Lessons
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Yang O, Yong J, Scott A.
Gerontologist 2021 Apr 14.
BACKGROUND AND OBJECTIVES: In recent years, countries have increasingly relied on markets to improve efficiency, contain costs, and maintain quality in aged care. Under the right conditions, competition can spur providers to compete by offering better prices and higher quality of services. However, in aged care, market failures can be extensive. Information about prices and quality may not be readily available and search costs can be high. This study undertakes a scoping review on competition in the nursing home sector, with an emphasis on empirical evidence in relation to how competition affects prices and quality of care. RESEARCH DESIGN AND METHODS: Online databases were used to identify studies published in English language between 1988 and 2020. A total of 50 studies covering nine countries are reviewed. RESULTS: The review finds conflicting evidence on the relationship between competition and quality. Some studies find greater competition leading to higher quality, others find the opposite. Institutional features such as the presence of binding supply restrictions on nursing homes and public reporting of quality information are important considerations. Most studies find greater competition tends to result in lower prices, although the effect is small. DISCUSSION AND IMPLICATIONS: The literature offers several key policy lessons, including the relationship between supply restrictions and quality which has implications on whether increasing subsidies can result in higher quality and the importance of price transparency and public reporting of quality.