In regression models that included average staffing, a higher percentage of below-average staffing days was significantly associated with worse quality for licensed practical nurses in 10 of 12 models, with the largest association for decline of activities of daily living among long-stay residents (regression coefficient, 0.020 P < .001). Mean (SD) staffing hours per resident-day were 0.44 (0.40) for registered nurses, 0.80 (0.32) for licensed practical nurses, and 2.20 (0.50) for certified nurse aides. Results For the 14 717 nursing homes in this study, the mean (SD) percentage of days with below-average staffing was 30.2% (12.0%) for registered nurses, 16.4% (11.3%) for licensed practical nurses, and 5.1% (5.3%) for certified nurse aides. Quality indicators included deficiency citations long-stay residents receiving an antipsychotic percentage of high-risk long-stay residents with pressure ulcers (2 different measures for pressure ulcers were used) and percentage of long-stay residents with activities of daily living decline, mobility decline, emergency department visits, and hospitalizations and short-stay residents with new antipsychotic medication, mobility decline, emergency department visits, and rehospitalizations. Below-average staffing days were defined as those 20% below the facility average, by staffing type. Main Outcomes and Measures Linear, random-effect models with state fixed effects and robust SEs were estimated for 12 quality indicators as dependent variables, percentage of below-average staffing days as independent variables, controlling for average staffing hours per resident-day for registered nurses, licensed practical nurses, and certified nurse aides. Statistical analysis was performed from February 8 to November 14, 2022. Objective To examine whether staffing instability, defined as the percentage of days below average staffing levels, is associated with nursing home quality when controlling for average staffing levels.ĭesign, Setting, and Participants This quality improvement study of 14 717 nursing homes used the merged Centers for Medicare & Medicaid Services Payroll Based Journal, Minimum Data Set, Nursing Home Care Compare, and Long-Term-Care Focus data for fiscal years 2017 to 2019. Whether that association holds when controlling for average staffing levels is unknown. Importance Recent work suggests that instability in nursing home staffing levels may be an important marker of nursing home quality. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine. Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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