General public s preferences for assessment criteria for choosing a nursing home

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Emory Garrett
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1 General public s preferences for assessment criteria for choosing a nursing home Max Geraedts 1, Thomas Brechtel 2, Ralf Zöll 2, Peter Hermeling 1 1 Institute for Health Systems Research, Witten/Herdecke University, Germany; 2 37Grad, consulting agency, Düsseldorf, Germany Institute for Health Systems Research - Faculty of Health - Witten/Herdecke University 1

2 Background In Germany, medical advisory service of Statutory Health Insurances (SHI) assesses nursing homes using 82 assessment criteria every year SHI and nursing homes publish data to enable informed choice Criteria developed without sufficient consideration of evidence on assessment criteria (e. g. Du Moulin et al., PEC 2010) or adequate participation of the general public Institute for Health Systems Research - Faculty of Health - Witten/Herdecke University 2

3 Aim / Hypotheses Aim: To explore the general public s preferences for assessment criteria to be published in report cards that aim to support the choice of a nursing home Hypothesis 1: Staff-related criteria (number, qualifications, empathy) and outcomes are rated more important than general structure or process indicators Hypothesis 2: Existing knowledge of nursing homes as well as socio-demographic and socio-economic status impact criteria s preference ratings Institute for Health Systems Research - Faculty of Health - Witten/Herdecke University 3

4 Methods Study Design: Written cross-sectional survey in spring 2011 Population studied: Representative sample of the German population aged years (N = 1782) Participants rated preferences related to 36 assessment criteria extracted from the literature, and were asked about existing knowledge of nursing homes and of nursing home report cards Descriptive analysis and ordinal regression analysis with adjustment for multiple testing to study differences between preference ratings taking age, gender, socioeconomic status and existing knowledge into account Institute for Health Systems Research - Faculty of Health - Witten/Herdecke University 4

5 Results: Existing knowledge 24% of participants with relatives or friends currently or during the last five years in a nursing home 20% actually visited relatives or friends in a nursing home 16% searched for a nursing home for themselves or relatives/friends during the last 2 years 4% expected to have to choose a nursing home in the near future Institute for Health Systems Research - Faculty of Health - Witten/Herdecke University 5

6 Rankings according to relevance ratings Criteria Ranking Relevance (%) Age 1 Gdr SES Staffing Respectful contact with residents Friendliness of nursing staff Qualification of nursing staff Number of nursing staff Nursing staff turnover Other structure-related criteria Quality of food and drinks Cleanliness of institution Regular medical attendance Finances and cost: direct care expenditures Individual interior design and room furnishing Individual daily schedules Quiet location in the green Central location next to downtown Age/Gender/SES: = significant in ordinal regression comparing age >59 // <60; women // men; highest SES // lowest SES Institute for Health Systems Research - Faculty of Health - Witten/Herdecke University 6

7 Rankings according to relevance ratings Criteria Ranking Relevance (%) Age 1 Gdr SES Care processes Sufficient time for nursing care Sufficient time for attention and conversation Assessment of risk for falls Evidence based nursing care Assessment by others First impression of institution (smell, atmosphere) Overall satisfaction of residents (survey result) Independent assessment of nursing institution Number of inspection deficiency citations Reputation of institution Recommended by friends or family Recommended by doctor Recommended by sickness funds Age/Gender/SES: = significant in ordinal regression comparing age >59 // <60; women // men; highest SES // lowest SES Institute for Health Systems Research - Faculty of Health - Witten/Herdecke University 7

8 Rankings according to relevance ratings Criteria Ranking Relevance (%) Age 1 Gdr SES Outcomes of care Prevalence of pressure sores Prevalence of moderate to severe pain Incidence of worsening depression or anxiety Prevalence of unexplained weight loss Prevalence of flu shots Prevalence of residents spending most of time in bed Prevalence of bladder or bowel incontinence Prevalence of indwelling catheters Incidence of increased need for help with daily activities Quality management Regular coaching / counseling of nursing staff Participation of institution in benchmarking activities Age/Gender/SES: = significant in ordinal regression comparing age >59 // <60; women // men; highest SES // lowest SES Institute for Health Systems Research - Faculty of Health - Witten/Herdecke University 8

9 Results: Independent variables Women rated 22 out of 36 criteria more important than men (especially staff-related criteria and assessment by others) >59-year olds rated 14 out of 36 criteria more important than younger participants (especially outcomes of nursing care) Socio-economic status: Participants with higher SES rated 7 out of 36 criteria more important Existing knowledge / concernment in terms of having chosen a nursing home during last 2 years: No associations with preference ratings Institute for Health Systems Research - Faculty of Health - Witten/Herdecke University 9

10 Conclusions Quality of staffing plays the most important role for German adults choosing a nursing home Outcomes of nursing care are not (yet) considered highly relevant Age and especially gender significantly impact preference ratings Existing knowledge of nursing homes / concernment does not impact preference ratings Institute for Health Systems Research - Faculty of Health - Witten/Herdecke University 10

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