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Care planning integrity in nursing facilities
Roma Lee Taunton1, Ubolrat Piamjariyakul, Byron Gajewski
1School of Nursing, University of Kansas, 3901 Rainbow Blvd., Kansas City, KS 66160, USA. rtaunton@kumc.edu
Nursing Research
|July 22, 2008
Summary
Nursing home care planning integrity, a model of coordination and integration, directly impacts quality and resident outcomes. This study identifies key factors influencing care quality in nursing facilities.
Area of Science:
- Nursing Home Administration
- Healthcare Quality Improvement
- Geriatric Care Management
Background:
- The 1987 Omnibus Budget Reconciliation Act (OBRA) regulations aimed to improve nursing home care quality, but the specific processes driving these improvements remain unclear.
- The role of standardized resident assessment and care planning tools in achieving quality improvements has not been empirically validated.
Purpose of the Study:
- To develop and validate a conceptual model of care planning integrity in nursing facilities.
- To identify the key subconstructs influencing care planning integrity: coordination, integration, interdisciplinary team, restorative perspective, and quality.
Main Methods:
- A correlational, model generation-model selection design was employed.
- Data were collected from 107 nursing facilities, including surveys from 508 care planning team members and data from Medicaid Cost Reports and the Online Survey, Certification, and Reporting (OSCAR) system.
- Structural equation modeling (SEM) was used to test the conceptual model of care planning integrity.
Main Results:
- An alternative model demonstrated excellent fit to the data (CFI=.972, RMSEA=.026), surpassing the primary model (CFI=.892, RMSEA=.048).
- Care planning integrity showed direct relationships with coordination, integration, and quality.
- Indirect relationships were observed through integration with the interdisciplinary team and restorative perspective.
Conclusions:
- Care planning integrity effectively explains variations in how nursing facilities implement care planning processes using standardized tools.
- These implementation differences are linked to variations in resident outcomes, highlighting the importance of care planning integrity.
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