Graduate School of Management

I-Shou University

Investigation on Aged Care Quality of Nursing Home Taking

Chain Nursing Homes of Kaohsiung District as Examples

-

IV

(

)()

(

)

Donabedian 94 1

3 3 5 283

4.6%

ADL 4.6%

ADL 5.7%

ADL

3.9% 25.1%

7.4%

ADL

V

Abstract Due to the demand of long-term aged care, the supply of nursing homes has been

increasing, and gradually aged care quality is under more and more attention. This study aims at investigating the correlation among organizational characteristics of chain nursing home (operation style, size, number of beds, number of nursing hours of nurses, number of caring hours of caregivers), characteristics of residents (extent of daily life dependence, number of diseases) and aged care quality (fall down rate, pressure sore rate, infection rate, non-planned weight loss, restraint rate, rate of non-planned transfer to intensive care hospital). Referring to Donabedians quality management theoretic model, this study adopts the description of relativity designs. Within a period of 3 months from January to March 2005, 5 chain nursing homes of Kaohsiung District were investigated. There were 283 nursing home residents being the samples. This study employs descriptive statistics and chi-square tests to conduct data analysis. The results of the data analysis show that the fall down rate of these samples is 4.6% and the prediction factors include the organizational operation style, education level of residents, ADL and psychiatric drugs taken; the pressure sore rate is 4.6% and the prediction factors include ADL, number of supportive tubes, nasogastric tube, and catheter; in-home infection rate is 5.7% and the prediction factors include organizational operation style, ADL, cognition, number of supportive tubes, nasogastric tube, tracheostomy tube and catheter; non-planned weight loss rate is 3.9%; restraint rate of residents is 25.1% and the prediction factors include organizational size and psychiatric drugs; the rate of non-planned transfer to intensive care hospital is 7.4% and the prediction factors include operation style and catheter. This study is concluded by proposing ADL and supportive tubes to be the main considerations for improving the aged care quality in future, and giving suggestions for future researches. Key words: nursing home, organizational characteristics, residents characteristics,

aged care quality

VI

1

3

4

5

7

10

16

21

25

29

31

35

36

37

38

39

41

48

50

52

61

VII

63

65

67

70

75

ADL 79

80

VIII

2-4-1 26

3-2-1 - 31

3-2-2 - 32

3-2-3 - 33

3-2-4 - 34

4-1-1 - 45

4-1-2 - 45

4-1-3 - 45

4-1-4 - 45

4-1-5 - 46

4-1-6 - 47

4-1-7 47

4-2-1 49

4-3-1 51

5-3-1 62

IX

311 30

1

2005 82 9 65

1,485,200 7.09

93 65 2,150,476

9.48 91 110

402 16.88 116 490

20.69 5

45

70 24

2000

163 200

1998 1998 7 1

2001 6 30

11,430

59.56

2.7

ADLs(Activites of daily living)

1994

2

3

(

)

(--

--

)

(

)

(

)()(

)

4

1-3-1

1-3-1

5

Institution Care

(1995)

Nursing Home

1.

2.Hospital-based Nursing Home

3.Independent Nursing Home

6

4.(Chain Nursing Homes)

(Reynolds & Stunden, 1979)

(aged care quality)

Donabedian1966structureprocess

outcome

fallpressure ulcer

infectionbody weight lossphysical restraint

prevalence

7

5 (1)

(2)(3)

(4)

(5)

(2001)

1985

Donabedian1966

(structure)(process)(outcome)

(Harris & Dugan, 19961999)

8

:

(patient-focused)

(provider-focused)(health care organization-focused)

(Benefield, 1996a, 1996bJennings, Staggers, & Brosch, 1999Madigan, Schott, &

Matthews, 2001)

(2001)

(Health Care Financing Administraion, HCFA) 15

Medicare Medicaid

Dellefield,2000Nyman(1988)

Iowa 1983 319

9

75

(2002)

1999(

199919951999

20002001200120022003)

carecure

1999

Zinn, Aaronson, & Rosko,1993

Davis,1991

10

1999

19991994

1998

LemkeMoos1986

11

1.

Porell Caro1998

2001 32

45

2003

2.

Porell Caro1998

Cohen Spector1996Spector Fortinsky19982003

200220012000

3.

2001 2000 3

6 115

2001

2002Spector William

1998

12

4.

2003

5.

Zinn et al.,1993Phillips et al., 1996

200020012003(2000) 10

6.

2001

Freiman Murtaugh(1993) 1987

2,790

2000

1994

1.

13

Porell Caro1998

2002 10

2001 45

2003

2.

Zinn 1993 Aarronson

1994 Porell Caro1998

Spector Fortinsky1998200320022001

2000

Aarronson et al.,1994Zinn et al.,1993

3.

Cherry1991

4.

2003

ADL

5.

Aarronson et al.,1994GraberSloane, 1995RetsasCrabbe, 1998

20032001Castle

14

1997

6.

Barbara Braun1991

FreimanMurtaugh1993 Intrator 1999

FreimanMurtaugh1993

Intrator 1999

Green Monahan1981

Green Monahan1981

Graber Sloane1995

(Aarronson et

al.,1994Zinn et al.,1993)

Zinn et al.,1993Graber Sloane,1995

Phillips et al.,1996

Munroe1990 1987 number of health

related deficiencies at annual survey California

455

15

Harrington2000

Dellefield

2000

(Medicaid)

Nyman1998 319

Graber Sloane1995

Porell Caro1998

Harrington

2000totaldeficiencies

numberquality of caredeficiencies number

quality of lifedeficiencies number

Nyman1988

Cherry1991

Graber Sloane1995

16

1.

1999

1.2 1

2003

ADLMustard Mayer1997

Ray2000 Benzodiazepines

1.44 Lord 1991

Harrison,Booth,Algase, 2001

Lord, Clark,Webster, 1991Tinneti, Doucette,Claus,1995

17

1996 ADLIADL

2.

1988

1988

/

2003ADL

74

ADL

3.

2000

2003

ADL

//

Garibaldi

1981

18

1998

Powers1989 UTI ADL

4.

Wright1993

Murden Ainslie1994

>10%--

Gants1997

23

Fabiny Kiel1997

43%

2002 156

2.21

44.2

16 42.3

2003

ADL

/

/

ADL Fabiny

19

Kiel1997 43%

Balm et al., 1995

5.

ADL

2000Sullivan-Marx, Strumpf, Evans,Baumgarten, 1999Burton et al.,

1992Castle et al., 1997Hawes et al., 1997Moseley, 19972003

ADL

Graber Sloane1995

Evans Strumpf1989

2001ADL

Zinn et al.,1993

1999

case mix

Davis1991 Brook McGlynn Shekell2000

Barbara Braun 1991

20

1995

2003

Fauman1989

1994

Spector Takada1991

Zimmerma1995

Kraft et al., 1987

21

19991999

(1996)

Barthels Index

Karnofskys

Barthel Index

Dorothea Barthel 1950

1965

7

3 2 3

100 0-20 21-60

61-90 91-99 100

(1996 2001)

22

Karnofsky scale

0-4 5

01

2

50

350

4

Activities of Daily Living ADLs

5 7

(

23

)(1996)

Instrumental Activities of Daily Living IADLs

( Lawton & Brody, 1969 )

8

1999

IADLs

1996

IADLs ADLs

ADL

IDALself-care

maintenance of independence, autonomy

ADL

IADL

24

(2000)2003

1920

ADL

50 ADL

Dencker K., Gottfries CG.,1995

25

Joint Commission on Accreditation of

Healthcare Organizations JCAHO

Hospitals & Health

SystemsMHA

MHAQuality IndicatorProject, QIP

QIP

unplanned weightchangepressure ulcer

prevalencedocumentedfalls rate

unscheduled transfer/ discharge toinpatient acute care rate

nosocomial infection incidence use of physical restraint rate

Association of Maryland Hospitals &HealthSystems, 2000

26

Davis, 1991; Dellefield, 2000;

Donabedian,1980

2000

Taiwan Quality Indicator Project,TQIP

(/

)

(2004)

2-4-1 2004

6 1. 1.

()(Tinetti1998)

2. =*100

2. 1.

(Maklebust1987Bride1993)

2.=*1000

27

3. 1.()

2.()

3.=/*1000

4. 1.

2. ()=()5/ 30*100

5. 1. (physical restraint)

2. =/

*100 6. 1.

2. /

*100

2001 32 0.02%

0.05 0.06% 0.07

0.49% 0.43 0

30 1.58%

23 0.26%

0.24 21.86% 18.01

28

0.67% 91.86%

42-47 (2002) 10

297

4.9% 2.9% 8.2%

4.5% 3.3% 7.8%

2003 52 2139

5.9% 19.4% 10.1%

11.8% 7.5% 2004 45

0.10-0.40%(

13.9%)2000 25.1%2002

46.6% Graber Sloane1995 32.6%

29

Donabedian1966structureprocess

outcome

/

2005 TQIP

(/

)

2004

30

case mix

Davis, 1991 Brook, McGlynn Shekell(2000)

Spector Takada(1991)

Zimmerman 1995

( 3-1-1)

311

31

3-2-1 3-2-2 3-2-3 3-2-4

3-2-1 -

1. 2.

1. 0-50 2. 50

100

8

12

32

3-2-2 -

94 3

1. 64 2. 65-74 3. 75-84 4. 85

1. 2.

1. 2. 3. 4. 5.

1. 2. 3. 4. 5.

20053

1. 1 ( 1 ) 2. 1-2 ( 2 ) 3. 2-3( 3 ) 4. 3-4( 4 ) 5. 4

33

3-2-3 -

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18.

1. 1 2. 2-3 3. 3

ADL ADLADL

10 10( B)

1. 2. 3. 4. 5.

5

1. 2. 3.

1. 2. 3. 4.

34

1. 2.

1. 2.

1. 2.

1. 2.

3-2-4 -

30

100

100 30

100 30 5

%

30 5 %100

100

100

35

ADL

36

2001

(

)(

)

--

()

3

1.

2.-

3.-ADL

4.

37

5 2005

3

5

(

)(--

--

)(

)

94 1 3 3 94 1

5

283 100

38

SPSS/PC 10.0

frequencypercent

Chi-Square test

ADL

39

5

(

)(--

--ADL)

(

)

40

94 1

94

(1999)

41

5

50 50

4-1-14-1-24-1-34-1-4

1. 1 20 4 80

2.88

75.9

3.60

51

4. 27977.2

26319.02 17630

15685

(

42

)(ADL

)

283 75-84

1 4-1-5

1. 75~84 131 46.3% 65~74 64

22.6%85 45 15.9%64 43 15.2%

84.8% 65 75

2. 153 54.1% 130 45.9%

3. 127 44.9%

90 31.8% 35 6.4% 18 6.4% 13

4.6%

4. 166 58.7% 80

28.3% 31 11% 6 2.1%

5. ( 1 ) 126 44.5%

1-2 74 26.1% 2-3

52 18.4% 3-4 22 7.8% 4

9 3.2%

2-3

43

36.4%30%

9.2%16.3%25.8%

4-1-6

1.

44 15.5%2-3 145 51.2% 3

94 33.2%

2.ADL 135 47.7% 81

28.6% 49 17.3% 13 4.6%

5 1.8%

3. 114 40.3% 145

51.2% 24 8.5%

4.

56 19.8% 34 12%

11 3.9% 85 30%

26 9.2%

46 16.3%

5. 73 25.8%

6

4-1-7

44

1. 13 4.6%

2. 13 4.6%

3. 16 5.7%

4. 11 3.9%

5. 71 25.1%

6. 21 7.4%

45

4-1-1 - N=5 %

1 4

20 80

4-1-2 - N=25

%

22 3

88 12

1 ( 1 ) 1-2 ( 2 ) 2-3 ( 3 ) 3-4 ( 4 )

7 15 2 1

28 60 8 4

4-1-3 - N=58

%

3 11 44

5.2 19

75.9

1 ( 1 ) 1-2 ( 2 ) 2-3 ( 3 ) 3-4 ( 4 )

30 19 8 1

51.7 32.8 13.8

1.7

4-1-4 -

27977.20 4486.45 20148 37778 26319.02 2202.11 21000 36685

46

4-1-5 N=283 % 64

65-74 75-84 85

43 64 131 45

15.2 22.6 46.3 15.9

153 130

54.1 45.9

127 90 18 35 13

44.9 31.8 6.4 12.4 4.6

166 31 6 80

58.7 11.0 2.1 28.3

1 ( 1 ) 1-2 ( 2 ) 2-3 ( 3 ) 3-4 ( 4 ) 4

126 74 52 22 9

44.5 26.1 18.4 7.8 3.2

47

4-1-6 N=283 % 1

2-3 3

44 145 94

15.5 51.2 33.2

ADL

135 81 49 13 5

47.7 28.6 17.3 4.6 1.8

114 145 24

40.3 51.2 8.5

182 56 34 11

64.3 19.8 12 3.9

85 198

30 70

26 257

9.2 90.8

46 237

16.3 83.7

73 210

25.8 74.2

4-1-7 N=283

%

13 270

4.6 95.4

13 270

4.6 95.4

16 267

5.7 94.3

11 272

3.9 96.1

71 212

25.1 74.9

21 262

7.4 92.6

48

4-2-1

62.6 29.58 92.52 13.62

0.61 0.16 0.43

0.82 0.39

2.19 0.27 2 2.67

0.67

38.53 8.41 2.82 0.61

5 0.15

0.16 0.14 0.14 0.2

0.28 0.09 0.10

0.69% 0.80 0.31

0.26

49

4-2-1 N=5

A B C D E 82 80 30 89 30 62.20 29.58 98.78 68.21 97.22 99.51 98.89 92.52 13.62

0.47 0.82 0.66 0.43 0.65 0.61 0.16 2.05 2.67 2.14 2.00 2.10 2.19 0.27 %

0.12 0.43 0.11 0.08 0 0.15 0.16 0 0.18 0.23 0.3 0 0.14 0.14 0 0.67 0 0.11 0.22 0.20 0.28

0.21 0.06 0 0.19 0 0.09 0.10 2.06 0.73 0.11 0.19 0.34 0.69 0.80

0.16 0.61 0.23 0 0.56 0.31 0.26

Adl 35.99 37.23 46.85 26.40 46.17 38.53 8.41 2.4 3 2.7 3.78 2.23 2.82 0.61

ABCDE 5

50

(Chi-square)

p

51

4-3-1 N=283

**8.589

0.412

***33.292

0.467

0.085

***11.285

1.549

0.307

0.822

3.145

***11.806

1.861

1.951 0.747 1.298 4.052 7.030

2.841

0.307 0.000 0.486 1.444 2.195

0.026

*12.45 2.057 4.850 4.694 8.730

0.521

0.471 0.811 6.189 1.887 4.963

8.806

4.256 2.494 7.965 2.239 9.813

10.269

0.590 1.044 1.120 0.160 3.101

10.648

ADL ***19.734 *10.994 *10.874 0.853 9.418

4.583

1.449

5.802 **11.536 5.066 2.460 1.828

3.314

***26.158 ***39.933 1.333 7.037 10.250

3.237

***19.316 ***26.649 1.295 6.733 5.390

1.378

0.627 ***33.857 0.000 1.383 2.643

0.734

***14.145 **9.419 0.031 0.294 *4.861

***13.430

0.053 0.006 0.013 **7.410 3.450

*p

52

2004

36 247 14.57

23

63.89 2004

1518

42.17

Graber Sloane1995

2004

1393 2004

91.77 92.52

2002

79.08 % 1996 Nursing Home

Yearbook 1000 65 53 94.5%

53

0.61

2.192001

1.17 2.29

1 5 1 15

2005 12

27977.2

2001 115 39000

37000 1999

38000-39700 2001

41590.31 32775

54

26319.022001

25700-304002001 24914.50-31242.59

75~84 46.3% 84.8% 65

7520012001

Evashwick & Langdon ,1996 65

88 % 75 70 %

2-3 51.22003

51.2%

1991199920002001

20012003

Aarronson et al., 1994;

Freiman & Murtaugh, 1993;Phillips et al., 1996; Spector & Takada, 1991

51.2%2003 64.936.4%

19992001

20032001

25.8%2003

19.9(

55

)

4.6%

4.6% 5.7% 3.9% 25.1%

7.4%

()

1.

200120032002Porell

Caro1998

1993

2002Porell Caro19982001

2003

2.

56

Alexander1996King 1995Kiely(1998)Tinneti

199520032001

1999Vassallo 2000

20032001

20031995

Fauman

1989

ADL2003Tinneti 1995 Kiely1998

ADL

1999

1994

2003

2003Mustard Mayer1997

RayThapa Gideon2000 Lord 1991

()

57

1.

Porell Caro1998

Spector Fortinsky199820032002

20012000

Arronson,1994Zinn et al., 1993

2.

William19982003

ADLBreslow et al, 1991

2003

1998

Bergstrom et al., 1996Berlowitz et al., 2001

()

1.

Spector

1998200120012002

2002

58

2003

2.

ADL Powers

198819982003

2003

1998

Garibaldi 1981Powers 1988

2003

2001

Powers 19882003

2001Powers et

al., 1988

()

1.

59

2003

1-2

2003

2.

Fabiny1997

ADL

Breslow et al, 19912003

ADL

//

ADL

Morley Kraenzle1994

Wright Gantz1997Gilmore 1995

()

1.

Aarronson et al.,1994GraberSloane, 1995RetsasCrabbe,

60

19982003

2.

ADL

2001 ADL

2002Sullivan-Marx, Strumpf, Evans,Baumgarten, 1999Burton et al.,

1992Caetle et al., 1997Hawes et al., 1997Moseley, 1997

Evans et al.,

1997Neufeld et al., 1999Sundel et al., 1994

()

1.

Freiman Murtaugh1993(2001)2000

2.

(Mulligan, 1991Murtaugh & Freiman, 1995)

61

2001 5-3-1

()

5 80

0.612001 32

65.62 1.17

92.522001 74.91

1999

()

Adl2001

75

()

2001

0.15% 0.14% 0.20% 0.09%

62

0.69% 0.31%

2001

5-3-1 2001 (n=5)

(n=32)

20.0 80.0

65.62 34.38

62.20 54.16 92.52 74.91

0.61 1.17 2.19 2.29

% 0.15 0.06 0.14 0.02 0.20 0.26

0.09 0.69 21.86

0.31 0.49

Adl 38.53 2.82

63

2000

64

11

1999

8

65

Harrington et al., 2000

1.

2.

66

3.

4.

67

2001

2005http://www.moi.gov.tw/stat/index.asp

1999

2004http://www.doh.gov.tw/statistic/index.htm

1998http://www.taipeilink.net/activity/doh/longtime/now.html

1999521-534

20009266-83 2000

199988 200089

20025154-64

1994132168-182 1996 DOH85-TD-066

1999 88 DOH88-TD-1026

1995143246-255

19997115-28

199532 138-147

2000926-18

68

2005-

http://www.tjcha.org.tw/quality/quality_b03b.asp 2002

199921-30

2002(MDS)46(1)57-64

(1996)156525-532

1994

2000 2001116382-387

199180DOH80-26

2001

1994

199815142-49

2002

2003MDS-

1999 1993194329-344

2000NSC89-2213-E150-003

199499170-174 200190

(MOI-DSA-089-011) 2000

69

2004-

3-14 199946683-88

2000105,338-341

20038(2)164-176

1998-

199832257-65

199924253-62

19951995383-402

200092160-194 2001-81-37

1998

1999

199643(2)63-68

19989313-21

2001

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