Medical Staff Organization in Nursing Homes: Scale Development and Validation

PURPOSE: To construct a multidimensional self-report scale to measure nursing home (NH) medical staff organization (NHMSO) dimensions and then pilot the scale using a national survey of medical directors to provide data on its psychometric properties. DESIGN AND METHODS: Instrument development process consisting of the proceedings from the Nursing Home Physician Workforce Conference and focus groups followed by cognitive interviews, which culminated in a survey of a random sample of American Medical Directors Association (AMDA) affiliated medical directors. Analyses were conducted on surveys matched to Online Survey Certification and Reporting (OSCAR) data from freestanding nonpediatric nursing homes. A total of 202 surveys were available for analysis and comprised the final sample. RESULTS: Dimensions were identified that measured the extent of medical staff organization in nursing homes and included staff composition, appointment process, commitment (physiciancohesion; leadership turnover/capability), departmentalization (physician supervision, autonomy and interdisciplinary involvement), documentation, and informal dynamics. The items developed to measure each dimension were reliable (Cronbach's alpha ranged from 0.81 to 0.65).Intercorrelations among the scale dimensions provided preliminary evidence of the construct validity of the scale. IMPLICATIONS: This report, for the first time ever, defines and validates NH medical staff organization dimensions, a critical first step in determining the relationship between physician practice and the quality of care delivered in the NH

Preference for Similarity in Higher and Lower Status Others

In interactions between lower and higher status individuals, higher status subjects preferred lower status others who had dissimilar patterns of performance, while lower status subjects preferred higher status others who had similar patterns of performance.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68670/2/10.1177_014616728173021.pd

Evaluation of a modified clinical prediction rule for use with spinal manipulative therapy in patients with chronic low back pain: a randomized clinical trial

Abstract Background Spinal Manipulative Therapy (SMT) and Active Exercise Therapy (AET) have both demonstrated efficacy in the treatment of Chronic Lower Back Pain (CLBP). A Clinical Prediction Rule (CPR) for responsiveness to SMT has been validated in a heterogeneous lower back pain population; however there is a need to evaluate this CPR specifically for patients with CLBP, which is a significant source of disability. Methods We conducted a randomized controlled trial (RCT) in Veteran Affairs and civilian outpatient clinics evaluating a modification of the original CPR (mCPR) in CLBP, eliminating acute low back pain and altering the specific types of SMT to improve generalizability. We enrolled and followed 181 patients with CLBP from 2007 to 2010. Patients were randomized by status on the mCPR to undergo either SMT or AET twice a week for four weeks. Providers and statisticians were blinded as to mCPR status. We collected outcome measures at 5, 12 and 24-weeks post baseline. We tested our study hypotheses by a general linear model repeated measures procedure following a univariate analysis of covariance approach. Outcome measures included, Visual Analogue Scale, Bodily pain subscale of SF-36 and the Oswestry Disability Index, Patient Satisfaction and Patient Expectation. Results Of the 89 AET patients, 69 (78%) completed the study and of the 92 SMT patients, 76 (83%) completed the study. As hypothesized, we found main effects of time where the SMT and AET groups showed significant improvements in pain and disability from baseline. There were no differences in treatment outcomes between groups in response to the treatment, given the lack of significant treatment x time interactions. The mCPR x treatment x time interactions were not significant. The differences in outcomes between treatment groups were the same for positive and negative on the mCPR groups, thus our second hypothesis was not supported. Conclusions We found no evidence that a modification of the original CPR can be used to discriminate CLBP patients that would benefit more from SMT. Further studies are needed to further clarify the patient characteristics that moderate treatment responsiveness to specific interventions for CLBP. Trial registration ISRCTN3051149

The Nursing Home Physician Workforce

Unlike a number of other health care professions practicing in nursing homes (NH), data specific to physicians is almost nonexistent. The only nationally representative study of physician practice in the NH was completed almost a decade ago and could not account for response bias owing to the nonrandom nature of the survey methodology employed.1 Nonetheless, only 1 in 5 physicians engaged in primary care noted involvement in NHs and spent an average of only 2 hours per week in the facility. No information was available in this study pertaining to physician-patient ratios in the NH or the mix of activities engaged in by physician providers. Although NHs are required to provide staffing data on an ongoing basis through online survey and certification reporting (OSCAR), physician-specific data are suspect. Feng et al2 recently demonstrated the nongeneralizability of OSCAR-generated physician data when compared to information gleaned from an intensive survey of medical directors, directors of nurses, and administrators. In contrast, the nursing shortage in NHs has been confirmed by OSCAR and has provided the basis for new policy and program initiatives

The Nursing Home Physician Workforce

Unlike a number of other health care professions practicing in nursing homes (NH), data specific to physicians is almost nonexistent. The only nationally representative study of physician practice in the NH was completed almost a decade ago and could not account for response bias owing to the nonrandom nature of the survey methodology employed.1 Nonetheless, only 1 in 5 physicians engaged in primary care noted involvement in NHs and spent an average of only 2 hours per week in the facility. No information was available in this study pertaining to physician-patient ratios in the NH or the mix of activities engaged in by physician providers. Although NHs are required to provide staffing data on an ongoing basis through online survey and certification reporting (OSCAR), physician-specific data are suspect. Feng et al2 recently demonstrated the nongeneralizability of OSCAR-generated physician data when compared to information gleaned from an intensive survey of medical directors, directors of nurses, and administrators. In contrast, the nursing shortage in NHs has been confirmed by OSCAR and has provided the basis for new policy and program initiatives