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A Systematic Literature Review of Efficiency Measurement in Nursing Homes.

ABSTRACT: Background: As our population ages at an increasing rate, the demand for nursing homes is rising. The challenge will be for nursing homes to maintain efficiency with limited resources while not compromising quality. This study aimed to review the nursing home efficiency literature to survey the application of efficiency methods and the measurements of inputs, outputs, facility characteristics and operational environment, with a special focus on quality measurement. Methods: We systematically searched three databases for eligible studies published in English between January 1995 and December 2018, supplemented by an exhaustive search of reference lists of included studies. The studies included were available in full text, their units of analysis were nursing homes, and the analytical methods and efficiency scores were clearly reported. Results: We identified 39 studies meeting the inclusion criteria, of which 31 accounted for quality measures. Standard efficiency measurement techniques, data envelopment analysis and stochastic frontier method, and their specifications (orientation, returns to scale, functional forms and error term assumptions) were adequately applied. Measurements of inputs, outputs and control variables were relatively homogenous while quality measures varied. Notably, most studies did not include all three quality dimensions (structure, process and outcome). One study claimed to include quality of life; however, it was not a well-validated and widely used measure. The impacts of quality on efficiency estimates were mixed. The effect of quality on the ranking of nursing home efficiency was rarely reported. Conclusions: When measuring nursing home efficiency, it is crucial to adjust for quality of care and resident's quality of life because the ultimate output of nursing homes is quality-adjusted days living in the facility. Quality measures should reflect their multidimensionality and not be limited to quality of throughput (health-related events). More reliable estimation of nursing home efficiencies will require better routine data collection within the facility, where well-validated quality measures become an essential part of the minimum data requirement. It is also recommended that different efficiency methods and assumptions, and alternative measures of inputs, outputs and quality, are used for sensitivity analyses to ensure the robustness and validity of findings.

SUBMITTER: Tran A

PROVIDER: S-EPMC6616898 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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A Systematic Literature Review of Efficiency Measurement in Nursing Homes.

Tran Alice A Nguyen Kim-Huong KH Gray Len L Comans Tracy T

International journal of environmental research and public health 20190620 12

<i>Background</i>: As our population ages at an increasing rate, the demand for nursing homes is rising. The challenge will be for nursing homes to maintain efficiency with limited resources while not compromising quality. This study aimed to review the nursing home efficiency literature to survey the application of efficiency methods and the measurements of inputs, outputs, facility characteristics and operational environment, with a special focus on quality measurement. <i>Methods:</i> We syst ...[more]

PMID: 31226787

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Project description:BACKGROUND: The geriatric nursing home population is vulnerable to acute and deteriorating illness due to advanced age, multiple chronic illnesses and high levels of dependency. Although the detriments of hospitalising the frail and old are widely recognised, hospital admissions from nursing homes remain common. Little is known about what alternatives exist to prevent and reduce hospital admissions from this setting. The objective of this study, therefore, is to summarise the effects of interventions to reduce acute hospitalisations from nursing homes. METHODS: A systematic literature search was performed in Cochrane Library, PubMed, MEDLINE, EMBASE and ISI Web of Science in April 2013. Studies were eligible if they had a geriatric nursing home study population and were evaluating any type of intervention aiming at reducing acute hospital admission. Systematic reviews, randomised controlled trials, quasi randomised controlled trials, controlled before-after studies and interrupted time series were eligible study designs. The process of selecting studies, assessing them, extracting data and grading the total evidence was done by two researchers individually, with any disagreement solved by a third. We made use of meta-analyses from included systematic reviews, the remaining synthesis is descriptive. Based on the type of intervention, the included studies were categorised in: 1) Interventions to structure and standardise clinical practice, 2) Geriatric specialist services and 3) Influenza vaccination. RESULTS: Five systematic reviews and five primary studies were included, evaluating a total of 11 different interventions. Fewer hospital admissions were found in four out of seven evaluations of structuring and standardising clinical practice; in both evaluations of geriatric specialist services, and in influenza vaccination of residents. The quality of the evidence for all comparisons was of low or very low quality, using the GRADE approach. CONCLUSIONS: Overall, eleven interventions to reduce hospital admissions from nursing homes were identified. None of them were tested more than once and the quality of the evidence was low for every comparison. Still, several interventions had effects on reducing hospital admissions and may represent important aspects of nursing home care to reduce hospital admissions.

Project description:Demand for nursing home (NH) care by patients with end-stage renal disease (ESRD) is likely to increase with growing numbers of older adults initiating chronic dialysis. We completed a systematic review to summarize the literature on NH residents with ESRD.MEDLINE, CINAHL, EMBASE, and relevant conference proceedings were searched to identify articles using the following MESH terms or related key words in the title or abstract: "residential facilities", "renal dialysis", "renal replacement therapy", and "chronic kidney failure". We selected case control, cohort studies, and clinical trials that included older adults with ESRD (defined as those receiving chronic dialysis or those with stage 5 chronic kidney disease) living in residential care facilities. We abstracted information on study design, quality, and results.Of 198 unique citations identified by the search strategy, 14 articles met eligibility criteria. Most articles were multicenter studies that were conducted in the 1990 s. One study focused on patients with stage 5 chronic kidney disease, and the remaining 13 studies focused on patients receiving chronic dialysis, of which eight studies included only those receiving peritoneal dialysis, four studies included patients receiving both peritoneal dialysis and hemodialysis, and one study included only patients receiving hemodialysis. All studies were observational, no clinical trials were identified, and study design limitations and heterogeneity within study populations were common. Summarizing results across these studies suggests that NH residents with ESRD have limited survival, particularly early after dialysis initiation. Functional impairment is highly prevalent in this population and independently associated with poor outcomes.NH residents with ESRD appear to be a particularly vulnerable population, but current information on their prevalence, characteristics, and outcomes is limited. Further research is needed to provide a better understanding of modifiable predictors of survival and functional decline in this population.

Project description:BackgroundPhysiotherapy can improve functional ability, prevent falls and reduce pain for older adults in nursing homes. However, there are no legislations or guidelines that specify the parameters of physiotherapy required in nursing homes. With the increasing healthcare demands of ageing populations worldwide, it is important to understand the current use of physiotherapy services to ensure they are both evidence-based and promote equity.Objectives(1) When and how are physiotherapy services used by older adults living in nursing homes? (2) What are the factors associated with use of physiotherapy services in nursing homes? (3) How are physiotherapy services in nursing homes documented and monitored?MethodsSeveral databases and grey literature (including MEDLINE, PubMed, Pedro and EMBASE) were searched following PRISMA guidelines in March 2018. Searches were limited to English language publications from 1997. Assessment for inclusion, data extraction and quality assessment were completed by two investigators independently using standardised forms. Studies were included if they considered any type of physiotherapy service that involved a qualified physiotherapist (such as exercise, massage and staff education) with older adults (aged 60 years and older) that were primarily permanent residents of a nursing home. Data extracted included proportion of clients that used physiotherapy services, type, frequency and duration of physiotherapy services, and factors associated with physiotherapy service use.ResultsEleven studies were included. Between 10% and 67% of nursing home clients used physiotherapy services. Factors associated with greater use of physiotherapy services included larger size facilities, and if clients had a physical impairment and mild or no cognitive impairment. Types of physiotherapy services reported were pain management and pressure ulcer management.ConclusionsPhysiotherapy service use in nursing homes varied widely. The development of physiotherapy benchmarks and quality standards are needed to support older adults in nursing homes. PROSPERO registration number: CRD42018082460.

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A Systematic Literature Review of Efficiency Measurement in Nursing Homes.

Publications

A Systematic Literature Review of Efficiency Measurement in Nursing Homes.

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