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A MULTIVARIATE APPROACH TO EXPLORE NURSING HOME CHARACTERISTICS CONTRIBUTING TO HIGH PERFORMANCE ON CMS’ PUBLICLY REPORTED QUALITY MEASURES
by
Kristine Rauch Mattivi
A Thesis Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTER OF SCIENCE
(APPLIED BIOSTATISTICS AND EPIDEMIOLOGY)
December 2011
Copyright 2011 Kristine Rauch Mattivi
Object Description
| Title | A multivariate approach to explore nursing home characteristics contributing to high performance on CMS' publicly reported quality measures |
| Author | Mattivi, Kristine Rauch |
| Author email | mokena.k3@gmail.com;mokena.k3@gmail.com |
| Degree | Master of Science |
| Document type | Thesis |
| Degree program | Applied Biostatistics and Epidemiology |
| School | Keck School of Medicine |
| Date defended/completed | 2011-07-25 |
| Date submitted | 2011-09-22 |
| Date approved | 2011-09-22 |
| Restricted until | 2011-09-22 |
| Date published | 2011-09-22 |
| Advisor (committee chair) | Azen, Stanley |
| Advisor (committee member) |
Unger, Jennifer Boley-Cruz, Tess |
| Abstract | Identifying and learning from nursing homes that are able to consistently provide high quality care to their residents is of great interest to policy makers, nursing home industry stakeholders, and nursing home staff. Previous studies have shown relationships between various organizational characteristics and outcome measures, often with conflicting results. This analysis explores relationships between commonly cited nursing home characteristics and high performance on the CMS publicly reported quality measures of physical restraints, high-risk pressure ulcers, chronic care pain, and post-acute care pain using stepwise multivariate logistic regression. One-year rolling average scores were calculated and compared to the high-performance tenth percentile for the baseline period. Preliminary univariate logistic regression showed significant associations between many characteristics and the high performance outcomes. Multivariate models demonstrated fair predictability as assessed by the c-index, but good fit was obtained only with the model for physical restraints. Models for high-risk pressure ulcers and post-acute care pain showed fair goodness of fit, and a good fit was not achieved for chronic care pain. Some characteristics produce opposite effects across the four outcomes, making it difficult for an individual nursing home to achieve high performance across multiple measures. It may not be desirable, or even possible, to change some of these factors, such as staffing levels or urban location. Recent studies emphasize the role of organizational culture on improving the quality of care. Reliable metrics for many of these characteristics, such as support of leadership and staff stability are not yet available. Learning networks such as the Advancing Excellence in America’s Nursing Home Campaign provide a platform for nursing home staff to access and implement best practices, as well as explore the development of additional process measures. Expected changes to outcome measures and development of uniform process measures will provide new directions for further investigation and potentially lead to greater understanding of the links between nursing home characteristics and the ability to provide good quality care. |
| Keyword | nursing homes; quality measures; high performance; multivariate logistic model |
| Language | English |
| Part of collection | University of Southern California dissertations and theses |
| Publisher (of the original version) | University of Southern California |
| Place of publication (of the original version) | Los Angeles, California |
| Publisher (of the digital version) | University of Southern California. Libraries |
| Provenance | Electronically uploaded by the author |
| Type | texts |
| Legacy record ID | usctheses-m |
| Rights | Mattivi, Kristine Rauch |
| Access conditions | The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the author, as the original true and official version of the work, but does not grant the reader permission to use the work if the desired use is covered by copyright. It is the author, as rights holder, who must provide use permission if such use is covered by copyright. The original signature page accompanying the original submission of the work to the USC Libraries is retained by the USC Libraries and a copy of it may be obtained by authorized requesters contacting the repository e-mail address given. |
| Repository name | University of Southern California Digital Library |
| Repository address | USC Digital Library, University of Southern California, University Park Campus MC 7002, 106 University Village, Los Angeles, California 90089-7002, USA |
| Repository email | cisadmin@usc.edu |
| Archival file | uscthesesreloadpub_Volume71/etd-MattiviKri-293.pdf |
Description
| Title | Page 1 |
| Full text | A MULTIVARIATE APPROACH TO EXPLORE NURSING HOME CHARACTERISTICS CONTRIBUTING TO HIGH PERFORMANCE ON CMS’ PUBLICLY REPORTED QUALITY MEASURES by Kristine Rauch Mattivi A Thesis Presented to the FACULTY OF THE USC GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree MASTER OF SCIENCE (APPLIED BIOSTATISTICS AND EPIDEMIOLOGY) December 2011 Copyright 2011 Kristine Rauch Mattivi |
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