Nursing home medical staff organization: correlates with quality indicators

Little is known about the relationship between how medical care is organized and delivered in nursing homes. Taking a lead from the acute care arena, we hypothesize that nursing home medical staff organization (NHMSO) is an important predictor of clinical outcomes in the nursing home.

A total of 202 usable surveys from a 2-wave survey process using the Dillman Method were returned from medical directors who were randomly selected from the AMDA membership and were asked to fill out a survey on the structure of medical organization in their primary nursing home practice. Quality measures that are likely to be affected by physician practice patterns were culled from NH Compare and OSCAR data sets and matched to the physician surveys, ie, long stay residents' prevalence of pain, restraint use, catheter use, pressure ulcers, pneumococcal vaccination, influenza vaccination, presence of advanced directives, prescription of antibiotics, and prevalence of depression.

Using a series of hierarchical multiple regressions, significant R(2) changes were found when the medical staff organization dimensions were added in the regressions after controlling for nursing home structural characteristics for the following outcomes: pneumococcal vaccination and restraint use. Near significant findings were noted for pain prevalence among long-stay residents, catheter use, and prevalence of pressure ulcers.

This study is the first to demonstrate a relationship between medical staff organizational dimensions and clinical outcomes in the nursing home setting and as such represents an initial "proof of concept." NHMSO should be considered as a potentially important mediating or moderating variable in the quality of care equation for nursing homes.