Trends and predictors of quality of care in VA nursing homes related to serious mental illness

Hyungjin M. Kim, Jane Banaszak-Holl, Helen Kales, Jennifer Mach, Fred Blow, John F. McCarthy

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

OBJECTIVE:: Within Veterans Affairs (VA) nursing homes (NHs), quality issues have a tremendous impact on the population with serious mental illness (SMI), who are more likely than their non-SMI Veteran counterparts to use NH services. We examined recent trends in quality indicators (QIs) measuring poor performance of VA NHs and whether the facility-level QIs vary with SMI concentration within the facility. METHODS:: From VA administrative records including Minimum Data Set assessments, we identified all residents in the 135 VA NHs between fiscal years 2005 (FY05) through FY07. We used a zero-inflated Poisson regression to assess trends in and facility-level predictors of 3 process-related QIs: depression without antidepressant therapy; bladder/bowel incontinence without a toileting plan; and physical restraint use. Facility-level predictors included collocated special care units, rurality, staffing, physical plant characteristics, SMI prevalence, and SMI admission volume. RESULTS:: During FY05-FY07, restraint use declined from 1.2% to 1.1% and incontinence without a toileting plan from 25.8% to 22.1%, but untreated depression increased from 5.1% to 5.5%. Despite overall gains in quality, higher SMI prevalence was associated with higher odds of physical restraint use and lack of toileting plan. Higher SMI prevalence was also associated with higher frequency of untreated depression. Other characteristics such as complex building structure were predictive of variation in quality, but the relationships were not consistent across QI types. CONCLUSION:: VA NHs had significant improvements in these examined QIs during the study period. Nonetheless, overall poorer quality was observed at sites with higher SMI concentrations.

Original languageEnglish (US)
Pages (from-to)659-665
Number of pages7
JournalMedical care
Volume51
Issue number8
DOIs
StatePublished - Aug 1 2013
Externally publishedYes

Fingerprint

Quality of Health Care
Veterans
Nursing Homes
Physical Restraint
Nursing Services
Antidepressive Agents
Urinary Bladder
Population

Keywords

  • nursing home
  • quality of care
  • serious mental illness

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Trends and predictors of quality of care in VA nursing homes related to serious mental illness. / Kim, Hyungjin M.; Banaszak-Holl, Jane; Kales, Helen; Mach, Jennifer; Blow, Fred; McCarthy, John F.

In: Medical care, Vol. 51, No. 8, 01.08.2013, p. 659-665.

Research output: Contribution to journalArticle

Kim, Hyungjin M. ; Banaszak-Holl, Jane ; Kales, Helen ; Mach, Jennifer ; Blow, Fred ; McCarthy, John F. / Trends and predictors of quality of care in VA nursing homes related to serious mental illness. In: Medical care. 2013 ; Vol. 51, No. 8. pp. 659-665.
@article{e276868a1e4b433dab4521040d72d785,
title = "Trends and predictors of quality of care in VA nursing homes related to serious mental illness",
abstract = "OBJECTIVE:: Within Veterans Affairs (VA) nursing homes (NHs), quality issues have a tremendous impact on the population with serious mental illness (SMI), who are more likely than their non-SMI Veteran counterparts to use NH services. We examined recent trends in quality indicators (QIs) measuring poor performance of VA NHs and whether the facility-level QIs vary with SMI concentration within the facility. METHODS:: From VA administrative records including Minimum Data Set assessments, we identified all residents in the 135 VA NHs between fiscal years 2005 (FY05) through FY07. We used a zero-inflated Poisson regression to assess trends in and facility-level predictors of 3 process-related QIs: depression without antidepressant therapy; bladder/bowel incontinence without a toileting plan; and physical restraint use. Facility-level predictors included collocated special care units, rurality, staffing, physical plant characteristics, SMI prevalence, and SMI admission volume. RESULTS:: During FY05-FY07, restraint use declined from 1.2{\%} to 1.1{\%} and incontinence without a toileting plan from 25.8{\%} to 22.1{\%}, but untreated depression increased from 5.1{\%} to 5.5{\%}. Despite overall gains in quality, higher SMI prevalence was associated with higher odds of physical restraint use and lack of toileting plan. Higher SMI prevalence was also associated with higher frequency of untreated depression. Other characteristics such as complex building structure were predictive of variation in quality, but the relationships were not consistent across QI types. CONCLUSION:: VA NHs had significant improvements in these examined QIs during the study period. Nonetheless, overall poorer quality was observed at sites with higher SMI concentrations.",
keywords = "nursing home, quality of care, serious mental illness",
author = "Kim, {Hyungjin M.} and Jane Banaszak-Holl and Helen Kales and Jennifer Mach and Fred Blow and McCarthy, {John F.}",
year = "2013",
month = "8",
day = "1",
doi = "10.1097/MLR.0b013e318293c28d",
language = "English (US)",
volume = "51",
pages = "659--665",
journal = "Medical Care",
issn = "0025-7079",
publisher = "Lippincott Williams and Wilkins",
number = "8",

}

TY - JOUR

T1 - Trends and predictors of quality of care in VA nursing homes related to serious mental illness

AU - Kim, Hyungjin M.

AU - Banaszak-Holl, Jane

AU - Kales, Helen

AU - Mach, Jennifer

AU - Blow, Fred

AU - McCarthy, John F.

PY - 2013/8/1

Y1 - 2013/8/1

N2 - OBJECTIVE:: Within Veterans Affairs (VA) nursing homes (NHs), quality issues have a tremendous impact on the population with serious mental illness (SMI), who are more likely than their non-SMI Veteran counterparts to use NH services. We examined recent trends in quality indicators (QIs) measuring poor performance of VA NHs and whether the facility-level QIs vary with SMI concentration within the facility. METHODS:: From VA administrative records including Minimum Data Set assessments, we identified all residents in the 135 VA NHs between fiscal years 2005 (FY05) through FY07. We used a zero-inflated Poisson regression to assess trends in and facility-level predictors of 3 process-related QIs: depression without antidepressant therapy; bladder/bowel incontinence without a toileting plan; and physical restraint use. Facility-level predictors included collocated special care units, rurality, staffing, physical plant characteristics, SMI prevalence, and SMI admission volume. RESULTS:: During FY05-FY07, restraint use declined from 1.2% to 1.1% and incontinence without a toileting plan from 25.8% to 22.1%, but untreated depression increased from 5.1% to 5.5%. Despite overall gains in quality, higher SMI prevalence was associated with higher odds of physical restraint use and lack of toileting plan. Higher SMI prevalence was also associated with higher frequency of untreated depression. Other characteristics such as complex building structure were predictive of variation in quality, but the relationships were not consistent across QI types. CONCLUSION:: VA NHs had significant improvements in these examined QIs during the study period. Nonetheless, overall poorer quality was observed at sites with higher SMI concentrations.

AB - OBJECTIVE:: Within Veterans Affairs (VA) nursing homes (NHs), quality issues have a tremendous impact on the population with serious mental illness (SMI), who are more likely than their non-SMI Veteran counterparts to use NH services. We examined recent trends in quality indicators (QIs) measuring poor performance of VA NHs and whether the facility-level QIs vary with SMI concentration within the facility. METHODS:: From VA administrative records including Minimum Data Set assessments, we identified all residents in the 135 VA NHs between fiscal years 2005 (FY05) through FY07. We used a zero-inflated Poisson regression to assess trends in and facility-level predictors of 3 process-related QIs: depression without antidepressant therapy; bladder/bowel incontinence without a toileting plan; and physical restraint use. Facility-level predictors included collocated special care units, rurality, staffing, physical plant characteristics, SMI prevalence, and SMI admission volume. RESULTS:: During FY05-FY07, restraint use declined from 1.2% to 1.1% and incontinence without a toileting plan from 25.8% to 22.1%, but untreated depression increased from 5.1% to 5.5%. Despite overall gains in quality, higher SMI prevalence was associated with higher odds of physical restraint use and lack of toileting plan. Higher SMI prevalence was also associated with higher frequency of untreated depression. Other characteristics such as complex building structure were predictive of variation in quality, but the relationships were not consistent across QI types. CONCLUSION:: VA NHs had significant improvements in these examined QIs during the study period. Nonetheless, overall poorer quality was observed at sites with higher SMI concentrations.

KW - nursing home

KW - quality of care

KW - serious mental illness

UR - http://www.scopus.com/inward/record.url?scp=84880714011&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84880714011&partnerID=8YFLogxK

U2 - 10.1097/MLR.0b013e318293c28d

DO - 10.1097/MLR.0b013e318293c28d

M3 - Article

C2 - 23632596

AN - SCOPUS:84880714011

VL - 51

SP - 659

EP - 665

JO - Medical Care

JF - Medical Care

SN - 0025-7079

IS - 8

ER -