Daily Variation in Nursing Home Staffing May Improve Quality Measures

With average staffing measures already a focus of quality assessments and reporting in nursing homes (NHs), researchers examined the association and effects of daily variation in staffing.

The quality improvement study focused on 13,339 certified NHs throughout the United States and included certified nurse aids (CNAs) and registered nurses (RNs). Study authors also conducted retrospective analyses of Medicare costs, the payroll-based journal (PBJ), and NH Care Compare analyzing from January 2017 to December 2018.

Researchers evaluated the association between coefficient of variation (COV), total outlier days (TOD), and low outlier days (LOD) for CNAs and RNs with quality rankings and other facility characteristics.

Study results showed a significant association with the 5-Star Quality Measures and all 3 variation measures for CNAs and RNs.

• “(COV among RNs, −0.014 [95% CI, −0.021 to −0.007]; P < .001; COV among CNAs: −0.004 [95% CI, −0.006 to −0.003]; P < .001;
• TOD among RNs, −3.79 [95% CI, −4.59 to −2.99]; P < .001; TOD among CNAs, −2.52 [95% CI, −3.08 to −1.96]; P < .001; LOD among RNs, −2.46 [95% CI, −3.03 to −1.88]; P < .001;
• LOD among CNAs, −1.29 [95% CI, −1.58 to −0.99]; P < .001) and the 5-Star Survey rankings (COV among RNs,−0.026 [95% CI, −0.033 to −0.019]; P < .001;
• COV among CNAs: −0.006 [95% CI, −0.007 to −0.004]; P < .001; TOD among RNs, −5.10 [95% CI, −5.97 to −4.23]; P < .001;
• TOD among CNAs, −4.16 [95% CI, −4.77 to −3.55]; P < .001; LOD among RNs, −3.04 [95% CI, −3.65 to −2.44]; P < .001; LOD among CNAs, −1.97 [95% CI, −2.29 to −1.65]; P < .001) published in [NH] Care Compare.” 

Findings showed reporting daily variation in staffing improved the understanding of the relationship between quality and staffing.

“The availability of the PBJ data as of 2017 opens new opportunities to study the associations between staffing and quality from perspectives that were not possible before and to apply new knowledge to policy and quality standards,” concluded researchers. “In this study, we took a first step in this direction, finding that daily variation in staffing levels was associated with NH quality.”

To understand daily variation in the broader context of goals for staffing and to determine the greatest measures, authors said more work is still required.

Reference:
Mukamel DB, Saliba D, Ladd H, Konetzka T. Daily variation in nursing home staffing and its association with quality measures. JAMA Netw Open. 2022;5(3):e222051. doi:10.1001/jamanetworkopen.2022.2051