The significant variation in the quality of nursing homes in the United States is of concern to many constituent groups, including nurses. Nursing employees, including certified nursing assistants, licensed vocational nurses, and registered nurses, comprise the largest employee group in the nursing home. Under the leadership of the registered nurse, the nursing staff has significant influence on the quality of care provided in the nursing home. Risk adjusted prevalence rates of pressure sores and nursing home survey deficiencies related to pressure sore prevention and treatment are important indicators of quality of care. These indicators may be significantly influenced by certain organizational structural features of both the department of nursing and the nursing home. The proposed study is a cross-sectional survey design using secondary data analysis. OSCAR data and facility annual financial disclosure reports published by OSHPD for California nursing homes participating in the Medicare and Medicaid programs in 1996 are used. All Medicare and/or Medicaid certified homes will be included in the study, which consist of 1,311 homes. The concept of resident risk, Donabedian's quality framework, and contingency theory are used to provide theoretical support for the study hypotheses. Three analyses will be done. The first analysis will use multiple regression for a risk adjustment model of the actual prevalence rate of pressure sores. Secondly, six hypotheses will be tested using multiple regression. Finally, five hypotheses will be tested using logistic regression.
