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BACKGROUND/RATIONALE:
Under the Veterans Millennium Health Care and Benefits Act of 1999 the VA is mandated to provide long-term care to eligible veterans in its 133 nursing home care units. While many veterans continue to receive care in community-based nursing homes through contractual arrangements with the VA, 75% of total VA nursing home expenditures are attributed to costs incurred by VA-operated homes. The VA's overall patient workload in nursing homes now averages 34,375 patients per day and accounts for expenditures of 2.4 billion dollars. As the number of older veterans increases dramatically over the next 2 decades, the demand for nursing home care will rise proportionally. While a number of structural and process characteristics of nursing homes have been examined over the years in terms of their relationship to quality the impact of the physician on the provision and quality of care in nursing homes has been largely ignored both in VA and non-VA settings. Specifically, medical staff organizational patterns in nursing homes have not been well described in contrast to the acute hospital literature which suggests a strong relatiohship to qualilty outcomes. Further, there is no extant centralized database within the VA that is able to quantify the numbers, types or organizational patterns of VA nursing home based health care providers.This knowledge gap must be addressed before rational policy can be articulated regarding the VA long-term care workforce.
OBJECTIVE(S):
Objectives:
The proposed study will quantify the medical structure and organization in VA nursing home care units and its' impact on health care outcomes. The purpose is to set the stage for a comprehensive research program on medical practice in VA nursing homes.
Objective I. To inventory all VA nursing homes as regards current leadership and administrative reporting relationships in order to develop a sampling frame for objectives II-IV.
Objective II. A Long Term Care Advisory Committee will be convened to vet a previously validated survey tool that measures dimensions of nursing home medical staff organizational (NHMSO) structure in order to ensure consonance with VA structure, language and culture..
Objective III. Initiate a feasibility study of the VANHMSO survey instrument using the total population of all medical directors in VA based nursing homes
Objective IV. Examine the hypothesized association of VA NHMSO dimensions with measures of nursing home quality.
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METHODS:
Phone interviews will be conducted with the leadership of each VA NHCU to characterize staff relationhships, responsibilities and facility demographics(Obj I). Based on a previously validated NHMSO instrument, and using information obtained through focus groups and cognitive interviews, the Long Term Care Advisory Committee will vet a new VANHMSO survey tool (Obj II). This survey is then distributedto all VA nursing home medical directors and refined by way of reliability and validity analyses in order to determine the feasibility and generalizability of a mail survey method to measure VANHMSO (Obj III). Using clustered multivariate regression models and the data from the feasibility study examine the hypothesized association of VA NHMSO dimensions with measures of nursing home quality (Obj IV).
FINDINGS/RESULTS:
Study to begin pending receipt of funding
IMPACT:
Significance:
The proposed study more clearly defines VA nursing home medical staff organizational models and their relationship to patient outcomes. This study will lay the groundwork for future interventions that will eventually lead to better quality of care, reduced health care costs and a more stable and productive nursing home workforce. Understanding how medical staffs are organized within VA nursing home care units is a prerequisite to managing a workforce that best meets the needs of an aging veteran population within a system characterized by increasing resource constraints. The following products will result from successful completion of the proposed project: 1) A database describing structural and medical staffing characteristics of VA nursing home care units (NHCUs) 2) A validated tool to quantify medical staff organization in VA nursing homes 3) New methods and metrics to quantify quality in VA nursing homes 4) Evidence base on the impact of medical staff organization on quality outcomes 5) Based on the evidence base above, stimulate intervention studies that optimize quality through different organizational models. 6) Provide data on the external validity or generalizability of the nursing home medical staff organization (NHMSO) model to the VA setting 7) A platform on which to benchmark VA nursing homes to community based facilities to identify best practices in later studies
PUBLICATIONS:
None at this time.
DRA:
Aging and Age-Related Changes, Health Services and Systems
DRE:
Quality of Care
Keywords:
Long-term care, Management, Quality assurance, improvement
MeSH Terms:
none
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