Breaking News
August 20, 2018 - Primary Care Provider Burnout Rate Low in Small Practices
August 20, 2018 - Discovery presents treatment hope for Alzheimer’s and other neurodegenerative diseases
August 20, 2018 - Stroke patients appear to receive better care at teaching hospitals with less chance of readmission
August 20, 2018 - Distinct origin of ADHD identified In children with history of traumatic brain injury
August 20, 2018 - AHA: Wildfire Smoke Threatens Health of Those Near and Far
August 20, 2018 - Here’s a mental health workout that’s as simple as ABC
August 20, 2018 - Newly discovered cytoskeleton utilized by cancer cells for survival
August 19, 2018 - Bifidobacteria supplement colonizes gut of breastfed infants
August 19, 2018 - Why patients with Alzheimer’s markers never develop the condition
August 19, 2018 - ACA’s Medicaid expansion associated with increase in prescriptions for opioid use disorder treatment
August 19, 2018 - Important factor may be missing in models used to predict spread of epidemics from climate change
August 19, 2018 - Indian-Americans have fewer sudden infant deaths, study finds
August 19, 2018 - Experts advise against universal genomic screening of newborns
August 19, 2018 - New trial to investigate whether weight loss before conception can make mom and baby healthier
August 19, 2018 - Sun Pharma Announces FDA Approval of Cequa (cyclosporine) Ophthalmic Solution to Treat Dry Eye Disease
August 19, 2018 - Researchers examining Parkinson’s resilience
August 19, 2018 - HPI, INTEGRIS and USPI enter into agreement to offer patients more choice, flexibility of care
August 19, 2018 - Researchers find mechanism that prepares brain to replicate repeated actions
August 19, 2018 - Those who are emotionally stable when young may remain the most stable as they age
August 19, 2018 - URI professor develops simpler and quicker method for detecting impurity in heparin
August 19, 2018 - Mayo Medical Laboratories and NDSC collaborate to develop new patient blood-management solution
August 19, 2018 - Insight into endocrine cancers and treatment options
August 19, 2018 - HPV Legislation Doesn’t Impact Teen Sexual Behaviors
August 19, 2018 - Exenatide treatment alleviated symptoms of depression in patients
August 19, 2018 - Tufts researchers win grant to study integration of genomic sequencing into neonatal care
August 19, 2018 - Novel finger-prick test can help prevent toxoplasmosis
August 19, 2018 - Cosmetic Procedures Boost Well-Being, Poll Shows
August 19, 2018 - Responsive parenting intervention results in lower BMIs through age three
August 19, 2018 - Anticancer drugs can help plants to battle infection
August 19, 2018 - Sunscreen from bathers releases significant quantities of polluting titanium dioxide into the sea
August 19, 2018 - Case Western Reserve gets three-year grant to enhance food systems in Cleveland neighborhoods
August 19, 2018 - Teenagers can thank their parents’ positive attitude for avoiding obesity
August 19, 2018 - Body mass index positively linked with blood pressure
August 19, 2018 - New tool fills gap in Small Molecules market
August 19, 2018 - Study compares survival outcomes in rural and urban cancer patients enrolled in clinical trials
August 19, 2018 - Researchers develop molecular matrix that delivers healing stem cells to injured elderly muscles
August 19, 2018 - Teva and Regeneron Announce Positive Topline Phase 3 Fasinumab Results in Patients with Chronic Pain from Osteoarthritis of the Knee or Hip
August 19, 2018 - New study pinpoints ways to improve quality of food and nutrition research
August 19, 2018 - Ology Bioservices wins $8.4 million worth agreement to manufacture anti-Ebola monoclonal antibody
August 19, 2018 - New CRISPR technology may help eliminate mutated gene sequence
August 19, 2018 - “Zombie gene” protects elephants from cancer finds study
August 19, 2018 - Study explores how many American cities protect the rights of employed breastfeeding mothers
August 19, 2018 - FDA Approves Lenvima (lenvatinib) for First-line Treatment of Unresectable Hepatocellular Carcinoma (HCC)
August 19, 2018 - Pain: Considering Complementary Approaches (eBook)
August 19, 2018 - Autoimmune response drives vision loss in glaucoma
August 19, 2018 - Tandem Diabetes Care introduces t:slim X2 Insulin Pump with Basal-IQ Technology in the US
August 19, 2018 - Innovative platform developed to destroy cancer cells
August 19, 2018 - Lowering pH inside tumor cells can slow down spread of cancer
August 19, 2018 - Biomarker predicts kidney cancer risk years before diagnosis
August 19, 2018 - Consequences of healthcare-associated infections go beyond patients’ physical health
August 19, 2018 - New drug- free, nanotechnology-based method detects and treats oral plaque
August 19, 2018 - Integration of Opioid, Infectious Disease Treatment Needed
August 19, 2018 - How eye disorders may have influenced the work of famous painters
August 18, 2018 - Blood biomarker could help predict kidney cancer up to five years prior to diagnosis
August 18, 2018 - Dartmouth scientists create more sustainable feed for aquaculture
August 18, 2018 - Immigrants Not a Burden on U.S. Health Care: Study
August 18, 2018 - Women who eat fast food take longer to become pregnant
August 18, 2018 - Most YouTube videos on plastic surgery are misleading marketing campaigns
August 18, 2018 - The essential guide to make your laboratory more sustainable
August 18, 2018 - Loyola Medicine offers scalp cooling treatment to reduce risk of chemotherapy hair loss
August 18, 2018 - Researchers describe promising strategy to remove melanoma’s most powerful defenses
August 18, 2018 - Women with polycystic ovary syndrome dissatisfied with medical care
August 18, 2018 - Research discoveries reveal insights behind neurological degeneration
August 18, 2018 - Researchers win multi-million Euro award to conduct research into liver disease
August 18, 2018 - Survey highlights variations in practice of airway management in pediatric intensive care units
August 18, 2018 - UK students win sponsorship from Promega Corporation
August 18, 2018 - Janssen Reports Positive Topline Results for ATLAS Phase III Study of a Novel, Long Acting Injectable Two-Drug Regimen for the treatment of HIV-1
August 18, 2018 - PSD as a molecular platform for understanding synapse formation and plasticity
August 18, 2018 - Improved visual communication could help patients to make informed health-care decisions
August 18, 2018 - New algorithm helps identify and manage diabetic patients at increased fracture risk
August 18, 2018 - Microscopic insect odour detecting mechanisms discovered
August 18, 2018 - Researchers develop new approach to study how tuberculosis infects people
August 18, 2018 - FDA Approves Kalydeco (ivacaftor) for Cystic Fibrosis in Children Ages 12 to
August 18, 2018 - An ion channel differentiates newborn and mature neurons in the adult brain
August 18, 2018 - Conditions of first sexual encounter can be indicators of future HIV risk and gender-based violence
August 18, 2018 - Socio-economic position associated with pregnant women’s exposure to environmental hazards
August 18, 2018 - Study evaluates how students change their breakfast consumption when given extra time
August 18, 2018 - Chronic perinatal hypoxia linked to locomotor miscoordination, long-term cerebellar learning deficits
August 18, 2018 - Voters to settle dispute over ambulance employee break times
August 18, 2018 - AGA urges policymakers and stakeholders to improve affordability of drugs
Mining a new data set to pinpoint critical staffing issues in skilled nursing facilities

Mining a new data set to pinpoint critical staffing issues in skilled nursing facilities

image_pdfDownload PDFimage_print

The Centers for Medicare & Medicaid Services is not known for linguistic playfulness. Nonetheless, at least one person there must have been chuckling when it named its rich new data source for nursing home staffing levels the Payroll-Based Journal, or PBJ.

Like that classic sandwich, the PBJ data set is irresistible. CMS created it to fulfill a requirement of the Affordable Care Act to improve the accuracy of its five-star staffing ratings on Medicare’s Nursing Home Compare website. The data set contains payroll records that nursing homes are required to submit to the government.

In April, Medicare began using them to rate staffing for more than 14,000 skilled nursing facilities (SNFs). The PBJ data gives a much better look at the how staffing relates to quality of care than the less precise — and too easy to inflate — staffing data Medicare had been using since 2008, which were based on two-week snapshots of staffing homes provided to inspectors. The data show staffing and occupancy on every day — an unprecedented degree of granularity that allows for new levels of inquiry.

Low staffing is a root cause of many injuries in nursing homes. As I wrote in the article published in The New York Times based on the data: “When nursing homes are short of staff, nurses and aides scramble to deliver meals, ferry bedbound residents to the bathroom and answer calls for pain medication. Essential medical tasks such as repositioning a patient to avert bedsores can be overlooked when workers are overburdened, sometimes leading to avoidable hospitalizations.”

Analyzing the files took time. To start with, the files were too large to analyze in Excel — a challenge with more and more health care data sets. I previously had taken classes in SQL at the National Institute for Computer-Assisted Reporting, but this was the first project in which I had to use SQL. Fortunately, KHN has two great data journalists who steered, taught and backstopped me: data editor Elizabeth Lucas and data correspondent Sydney Lupkin.

There were a lot of decisions to make in the analysis. Should we count nursing administrators in assessing staffing levels? How should we define best-staffed and worst-staffed days? How do we handle the fact that the data in its raw form wasn’t risk-adjusted — that is, that it didn’t tell you how comparatively frail and sick each nursing home’s residents were, making it dangerous to make comparisons. (You can read our decisions in our methodology, which accompanies the downloadable data.)

I guided myself with two intersecting principles: to reflect residents’ lived experience as accurately as possible, and to be fair to the facilities. When in doubt, I erred on the side of caution.

I bounced approaches off not only Liz and Sydney, but two of the top health care researchers who have published studies on staffing: David Stevenson at Vanderbilt University Medical Center and David Grabowski at Harvard Medical School. Both are straight shooters and rigorous in their methods. It was also invaluable to talk early on in the project to the nursing home industry’s trade group, the American Health Care Association, to solicit its views about the strengths and weaknesses of the data set.

I’ve been writing about nursing homes for a while, but until this story I didn’t know the source value of SNF resident and family councils. These councils are authorized by CMS, and facilities must let them meet on their premises and invite to their meetings anyone they want, including journalists.

The leaders of the council at Beechtree Center for Rehabilitation & Nursing, the Ithaca, N.Y., home that provided the anecdotes for the story, were a reporter’s dream: smart, dedicated and reasonable. They were able to see things from the facility administration’s position, but also were firm advocates for good care. They had educated themselves about the facility and the rules and regulations. Adam Chandler, whose mom was in Beechtree and whom I quoted in the story, had already been studying the PBJ data. The council’s president, Stan Hugo, carried around a tan notebook where he jotted down incidents of staffing problems he came across. He also kept a daily log of how many employees he observed when visiting his wife and how many the administration said were on duty in the sign Medicare requires them to post publicly.

Our story ultimately focused on the wide fluctuations in nursing home staffing day to day, with staffing consistently plummeting on weekends. Caitlin Hillyard, one of KHN’s web producers, created a terrific interactive graphic that reporters can use to see staffing patterns in nursing homes in your state. We encourage other reporters to download and use the data for their own stories. There’s no cost — just please credit KHN and provide a link back to us.

KHN’s coverage of these topics is supported by John A. Hartford Foundation and The SCAN Foundation

Jordan Rau: [email protected], @JordanRau

Kaiser Health NewsThis article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Tagged with:

About author

Related Articles