Organizational Context and Quality Indicators in Nursing Homes: A Microsystem Look

Author:

Duan Yinfei1ORCID,Hoben Matthias12,Song Yuting13ORCID,Chamberlain Stephanie A.1,Iaconi Alba1,Choroschun Katharina4,Shrestha Shovana1ORCID,Cummings Greta G.1ORCID,Norton Peter G.5,Estabrooks Carole A.1

Affiliation:

1. Faculty of Nursing, University of Alberta, Edmonton, AB, Canada

2. Faculty of Health, York University, Toronto, ON, Canada

3. School of Nursing, Qingdao University, Qingdao, China

4. School of Public Health, Bielefeld University, Bielefeld, Germany

5. Department of Family Medicine, University of Calgary, Calgary, AB, Canada

Abstract

The association of organizational context with quality of care in nursing homes is not well understood at the clinical microsystem (care unit) level. This cross-sectional study examined the associations of unit-level context with 10 unit-level quality indicators derived from the Minimum Data Set 2.0. Study settings comprised 262 care units within 91 Canadian nursing homes. We assessed context using unit-aggregated care-aide-reported scores on the 10 scales of the Alberta Context Tool. Mixed-effects regression analysis showed that structural resources were negatively associated with antipsychotics use (B = −.06; p = .001) and worsened late-loss activities of daily living (B = −.03, p = .04). Organizational slack in time was negatively associated with worsened pain (B = −.04, p = .01). Social capital was positively associated with delirium symptoms (B = .12, p = .02) and worsened depressive symptoms (B = .10, p = .01). The findings suggested that targeting interventions to modifiable contextual elements and unit-level quality improvement will be promising.

Funder

Canadian Institutes of Health Research

Publisher

SAGE Publications

Subject

Geriatrics and Gerontology,Gerontology

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