CLINICAL INDICATORS DERIVED FROM THE PATIENT ASSESSMENT INSTRUMENT IN THE LONG-STAY RESIDENTS OF 69 VA NURSING-HOMES

被引：13

作者：

RUDMAN, D

BROSS, D

MATTSON, DE

机构：

[1] The Department of Medicine, Medical College of Wisconsin, Medical Service, VA Medical Center, Milwaukee, Wisconsin

[2] Office of Quality Management, VA Central Office, Washington, District of Columbia

来源：

JOURNAL OF GENERAL INTERNAL MEDICINE | 1994年 / 9卷 / 05期

关键词：

NURSING HOMES; OUTCOMES; ACTIVITIES OF DAILY LIVING; VETERANS AFFAIRS; CLINICAL INDICATORS;

D O I：

10.1007/BF02599652

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Objectives: Previous work has shown that clinical indicators reflecting occurrence of bedsores, behavioral disturbances, and deterioration of activities of daily living (ADLs) can be calculated for the long-stay residents of Veterans Affairs (VA) nursing homes from the standard biannual patient Assessment Instrument (PAI). The present study aimed to construct national curves for these indicators, against which each facility could in the future compare its own values; and to determine the correlations between the indicator values and selected nursing home characteristics. Methods: Eight indicators were calculated for the long-stay (more than six months) residents of the 69 VA nursing homes housing 50 or more such patients from the 1992 PAI data. The indicators were: prevalence of bedsores; incidence of bedsores; prevalence of physically aggressive behavior; incidence of aggressive behavior; and frequencies of six-month losses of eating, mobility, transfer, and toileting functions by the initially independent residents. Results: There was 2 two- to sixfold difference between the most favorable quartile and the least favorable quartile for the eight indicators. Significant correlations across institutions were found between the prevalence and incidence of bedsores, the prevalence and incidence of aggressive behavior, and the frequencies of declines in the four ADLs by the initially independent residents. One or several of the indicators were significantly superior in nursing homes with these Characteristics: 2 smaller size, a slower resident turnover rate, a smaller proportion of residents with nonorganic psychoses, a lower ratio of short-stay to long-stay residents, and a lower ratio of independent to dependent long-stay residents. Conclusions: These data provide national standards against which each VA nursing home can compare its PAI-derived clinical indicator values. The outcomes measured by these indicators appear to be influenced both by casemix and by environmental factors.

引用

页码：261 / 267

页数：7

共 16 条

[1]

Improving the Quality of Care in Nursing Homes, (1986)

[2]

Quality Assurance in Long Term Care, (1989)

[3]

Rudman D., Abbasi A.A., Tourky G.M., Rudman I.W., Mattson D.E., Easily measurable adverse outcome indicators in a Veterans Affairs nursing home, QRB, 16, (1990)

[4]

Alverno L., Mattson D.E., Rudman D., Indicators of adverse somatic outcome in three Veterans Affairs nursing homes, Hosp Community Psychiatry, 43, (1992)

[5]

Rudman D., Alverno L., Mattson D.E., Physically aggressive behavior in two nursing homes, Hosp Community Psychiatry, 44, (1993)

[6]

Rudman D., McCormack J., Cuisinier M., Mattson D.E., A simple method to quantify the changes in activities of daily living of long stay nursing home populations, Am J Phys Med Rehabil, 72, (1994)

[7]

Rudman D., Slater E.J., Richardson T.J., Mattson D.E., The occurrence of pressure ulcers in three nursing homes, J Gen Intern Med, 8, (1993)

[8]

Rudman D., Mattson D.E., Alverno L., Richardson T.J., Rudman I.W., Comparison of clinical indicators in two nursing homes, J Am Geriatr Soc, 41, (1994)

[9]

Lawton M.P., The impact of the environment on aging and behavior, Handbook of the Psychology of Aging, pp. 276-301, (1977)

[10]

Tinetti M.E., Liu W.L., Marottoli R.A., Ginter S.F., Mechanical restraint use among residents of skilled nursing facilities! Prevalence, patters and predictors, JAMA, 265, (1991)

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