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Biomedical subjects

D Brannon

Publications and source records attributed to D Brannon.

At least 19 recordsLinked to original sources
PubMed1999

Organizational and environmental factors associated with nursing home participation in managed care.

OBJECTIVE: To develop and test a model, based on resource dependence theory, that identifies the organizational and environmental characteristics associated with nursing home participation in managed care. DATA SOURCES AND STUDY SETTING: Data for statistical analysis derived from a survey of Directors of Nursing in a sample of nursing homes in eight states (n = 308). These data were merged with data from the On-line Survey Certification and Reporting System, the Medicare Managed Care State/County Data File, and the 1995 Area Resource File. STUDY DESIGN: Since the dependent variable is dichotomous, the logistic procedure was used to fit the regression. The analysis was weighted using SUDAAN. FINDINGS: Participation in a provider network, higher proportions of resident care covered by Medicare, providing IV therapy, greater availability of RNs and physical therapists, and Medicare HMO market penetration are associated with a greater likelihood of having a managed care contract. CONCLUSION: As more Medicare recipients enroll in HMOs, nursing home involvement in managed care is likely to increase. Interorganizational linkages enhance the likelihood of managed care participation. Nursing homes interested in managed care should consider upgrading staffing and providing at least some subacute services.

Contract Services↗
PubMed1998

Profiles of hospital, physician, and home health service use by older persons in rural areas.

Using data from the Medicare Current Beneficiary Survey, we identify differences in hospital days, home health visits and physician office visits across five geographical categories. After controlling for individual characteristics and availability of health care providers, we find significant differences in service use. Results show greater use of home health care and less use of physician office visits and hospital care in rural areas. Because service use exhibits patterns of substitution and complementarity, future research on the use of health services needs to move beyond modeling the use of single services to modeling the range of services used.

Aged↗
PubMed1998

Resource dependence and institutional elements in nursing home TQM adoption.

OBJECTIVE: To examine the contextual attributes that influence nursing home TQM adoption, as informed by resource dependence and institutional theories. DATA SOURCES: A survey of licensed nursing home administrators in the Commonwealth of Pennsylvania during 1994-1995, the Medicare and Medicaid Annual Certification Survey (MMACS) data file, and the Area Resource File (ARF). STUDY DESIGN: Because the dependent variable (TQM adoption vs. non-adoption) is dichotomous, the model was estimated using logistic regression. DATA COLLECTION: Of the 615 facilities that were mailed surveys, 241 (39.2%) returned completed questionnaires. No significant differences were observed between respondents and nonrespondents in size, for-profit status, system membership, registered nurse staffing, cited licensure deficiencies, Medicare census, or Medicaid census. PRINCIPAL FINDINGS: Perceived competition, Medicare's share of total hospital discharges in the market, and facility Medicare census were significant predictors of TQM adoption. CONCLUSIONS: Our results provide limited support for the association between some rational adaptive and institutional factors and TQM adoption in nursing homes. Perceived competition and the influence of the Medicare program both at the facility and the market level are associated with TQM adoption. However, other factors associated with TQM adoption in other industries, such as size, are not associated with TQM adoption in the nursing homes in this study.

Aged↗
PubMed1997

Quality improvement in nursing care facilities: extent, impetus, and impact.

This study examines the extent, motivation, and performance implications of normal quality improvement (QI) programs in Pennsylvania nursing care facilities. Responses to a 20-item survey sent to facility administrators indicate that continuous quality improvement/total quality management (CQI/TQM) adopters are more motivated by quality of care and human resource concerns in implementing QI, more satisfied with the results of QI efforts, and more aware of a competitive environment than are non-adopters. There are few differences between adopters and non-adopters with respect to organizational characteristics or performance on quality of care measures. Comparison with the results of a study of QI implementation in hospitals reveals some differences in motivation, but similarities in satisfaction with results.

Factor Analysis, Statistical↗
PubMed1997

Quality improvement in nursing homes.

Regulation, competition, and cost containment have focused attention on quality improvement in nursing homes. Definition, measurement, and monitoring of quality are essential components of any program designed for quality assurance or continuous quality improvement.

Economic Competition↗
PubMed1997

Specialization and diversification in the nursing home industry.

Recent increases in the types of services offered by nursing facilities and in the formation of specialized care units have resulted in the emergence of two distinct but broadly defined types of services: subacute and long-term care. The authors examine the market, regulatory, and structural incentives behind diversification and specialization and speculate how these trends will affect the future of the nursing home industry.

Economic Competition↗
PubMed1996

Using TQM to improve management of home health aides.

Home health aides are at the front line of the home health industry, raising quality of care issues and human resource (HR) management challenges. Total quality management (TQM) provides a framework to help meet those challenges. The authors investigated the relationship between TQM and HR effectiveness in home health agencies. Results suggest that TQM practices are related to HR effectiveness. Suggestions are offered to make human resource management consistent with a TQM culture.

Home Care Services↗
PubMed1996

Discriminant analysis: a technique for adding value to patient satisfaction surveys.

Quality improvement in healthcare organizations requires effective measurement of patient satisfaction. This paper describes a methodology that identifies dimensions of care most closely associated with overall perceptions of quality. A patient satisfaction survey was mailed to 2,055 discharged patients of 13 home health agencies. Patients were asked to evaluate service dimensions of home health relating to scheduling, nursing care, home health aide services, and discharge arrangements. Overall satisfaction with quality of services was used as the dependent variable in two discriminant analysis equations. Eleven dimensions discriminated between "excellent" and "good" quality, and seven dimensions discriminated between "satisfactory" and "unsatisfactory" quality. Using discriminant analysis, items most closely associated with quality indeces can be identified and used in CQI initiatives.

Data Collection↗
PubMed1995

Organizing for nursing home quality.

This article explores the relationship between job, work group, and organizational design and the quality of nursing home care. Contingency theorists contend that effective organizations develop structures that support the nature of their production processes and complement their environment. Within the same facility, units with differing care requirements should be structured differently to achieve quality outcomes. Efforts to improve quality can be integrated through the practice of total quality management and facilitated by using the Health Care Financing Administration Minimum Data Set.

Efficiency, Organizational↗
PubMed1994

The effect of primary nursing job design dimensions on caregiving technology and job performance in nursing homes.

Primary nursing job design, ie permanent assignment and increased job autonomy and communication, has been suggested as especially appropriate for long-term care. The present study examined its effects on nursing home assistants' (N = 248) job performance and technology perceptions. Job design was found to have a significant effect on caregiving technology, even after controlling for individual differences. In particular, increased autonomy was significantly related to increased task variability which suggests that nursing assistants who have more job autonomy provide more customized care. Unexpectedly, increased duration of assignment was significantly related to increased homogeneity of tasks. Suggestions for future job design research in long-term care are made.

Attitude of Health Personnel↗
PubMed1994

Human resources management practices and patient satisfaction in home health care.

Patient satisfaction is an important issue for home health providers. This study tested the influence of organizational factors, particularly human resource management practices, on quality of care, as measured by patient satisfaction. Six hundred ninety-six patients of thirteen home health agencies were surveyed to test the influence of organizational factors on five dimensions of patient satisfaction. Organizational variables included size of the agency, staffing characteristics, educational preparation of RNs, continuing education, and compensation. We found that full-time staffing, the number of BSN-prepared RNs, and percent of budget allocated to benefits all predicted high patient satisfaction scores.

Data Collection↗
PubMed1992

Time and cost analysis of a computer-assisted telephone interview system to collect dietary recalls.

This study, conducted in 1991, examined the time requirements and costs of obtaining 24-hour dietary recalls via telephone interviews using the University of Minnesota's microcomputer Nutrient Data System to conduct the interviews and compute the nutrient composition of the diets. The subjects were 156 hypercholesterolemic children (aged 4-10 years) and 102 hypercholesterolemic adults (aged 21-65 years), who were participating in ongoing cholesterol education programs. A total of 391 recalls were completed with the children and 278 with the adults. For each completed interview, 3.5 and 2.8 attempts were required, respectively. Evenings were the most productive time for completing interviews. All tasks associated with completing the interviews (attempts to call, interviews per se, and postinterview procedures) required an average of 39.7 and 35.5 minutes per completed interview with the children and adults, respectively. About half of these total times were actually devoted to conducting the interview. The costs per completed interview were $9.22 for the children versus $6.99 for the adults. This difference reflects the greater number of attempts required to reach the children, the longer duration of their interviews, and the higher intrastate toll rates for calls to them as compared with the interstate rates for calls to the adults.

Adult↗
PubMed1992

Improving nursing home care through training and job redesign.

Nursing assistants have the primary contact with older residents of nursing homes. The Penn State Nursing Home Intervention Project's short-term longitudinal study assessed the single and combined effects of two interventions designed to affect nursing assistants' performance by increasing their knowledge and motivation: skills training and job redesign. Statistically significant differences in nursing assistants' knowledge were evident in comparisons between intervention and control sites, but performance was not improved. Implications for policy, practice, and research are discussed.

Evaluation Studies as Topic↗
PubMed1992

Survey of health promotion in Pennsylvania nursing homes.

Health promotion programs for residents represent a discretionary organizational response to increased demand for service differentiation within the nursing home setting. More than half (57%) of facilities in a systematic sample of Pennsylvania nursing homes reported offering one or more health promotion programs. This article describes the variety of topical categories of programs. Guided by two alternative explanations of medical technology adoption--the key professional model versus the institutional/environmental model--an explanation is offered about why some facilities offer such programs and others do not.

Evaluation Studies as Topic↗
PubMed1992

The psychosocial quality of nursing home work.

Trained observers used components of the functional job analysis technique to categorize 3,371 tasks performed by 214 nursing assistants in four nursing homes on five occasions over 12 months. The extent to which each task was oriented toward residents versus data or things was coded along with the "level of complexity" of each of these orientations. A psychosocial index was created by multiplying orientation by complexity. Three questions structured the analyses: (a) To what extent do nursing assistants' tasks involve interacting with residents, as opposed to focusing on data or manipulating things? (b) How complex are these tasks? (c) What are the implications of the task analysis data for assessing the quality of psychosocial care? Findings reveal that even among the direct care tasks (69% of total), the orientation was not predominantly toward the resident. Functional complexity of the tasks observed was consistently low. Those task types with the greatest psychosocial quality were those performed least frequently and vice versa. Implications of these results for restructuring nursing assistants' work are discussed.

Data Collection↗