Understanding how the organizational context of nursing facilities affects resident function is vital to the development of organizational policy to improve resident care outcomes and to improve clinical practices that occur within the constraints of organizational context. Previous research, however, has failed to integrate clinical models of functional status with policy models of the relationship between facility structure and resident outcomes. This study will combine clinical and health policy models of resident functioning to measure the effect of facility structural and process attributes on the relationship between resident disease and disability in the performance of activities of daily living (ADLs). Resident data from five states participating 5 in the Case Mix and Quality Demonstration Project during the years 1995-1996 will be linked to facility data from the On-line Survey, Certification, and Reporting System (OSCAR) to: 1) examine the stability of s organizational attributes of management structure, staffing, unit specialization and risk-adjusted quality indicators of care processes (as developed by Zimmerman et al 1995) across a 2-year time period; and 2) to identify subgroups of nursing home residents by disability risk factors of pathology, impairments, and limitations, that experience more rapid decline in ADL performance as a result of facility structure and care g processes using multilevel modeling of the linked data. The study will extend our current knowledge by utilizing a larger sampling frame and employing a longitudinal dataset with more recent data than previous research. Research findings can inform policy and clinical practice by quantifying the effect of facility structure and care processes on resident trajectories of disability to strengthen the empirical basis for the development of improved regulatory structures and targeted clinical interventions.
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