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Qual Manag Health Care. 2008 Jul-Sep;17(3):242-51. doi: 10.1097/01.QMH.0000326729.78331.c5.

An analysis of nursing home quality measures and staffing.

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  • 1Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA.



The purpose of this retrospective study was to evaluate nursing home quality measures (QMs) available in a national database called Nursing Home Compare. The aim was to determine whether differences in QM scores occurred with changing staffing-level mix.


All Missouri nursing home facilities were included for the analysis of the 14 QMs downloaded in February 2004.


Analyses of variance were used to examine differences in the dependent QM scores; the independent range of staffing levels for 3 disciplines, certified nurse assistant (CNA), licensed practical nurse (LPN), and registered nurse (RN), was analyzed on the basis of their number of hours per resident per day worked in the nursing home. Planned contrasts and post hoc Bonferroni adjustments were calculated to further evaluate significance levels. Finally, residents were used as a covariate to determine effects on significant analyses of variance.


Care is proportionate to the percentage of CNA/LPN/RN staffing-level mix, with 2 long-stay QMs (percentage of residents who lose bowel or bladder control and percentage of residents whose need for help with activities of daily living has increased) and 2 short-stay measures (percentage of residents who had moderate to severe pain and percentage of residents with pressure ulcers) revealed differences in mean quality scores when staffing levels changed.

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