Organizational Context and Quality Indicators in Nursing Homes: A Microsystem Look

Abstract

The association of organizational context with quality of care in nursing homes is not well understood at the clinical microsystem (care unit) level. This cross-sectional study examined the associations of unit-level context with 10 unit-level quality indicators derived from the Minimum Data Set 2.0. Study settings comprised 262 care units within 91 Canadian nursing homes. We assessed context using unit-aggregated care-aide-reported scores on the 10 scales of the Alberta Context Tool. Mixed-effects regression analysis showed that structural resources were negatively associated with antipsychotics use (B = −.06; p =.001) and worsened late-loss activities of daily living (B = −.03, p =.04). Organizational slack in time was negatively associated with worsened pain (B = −.04, p =.01). Social capital was positively associated with delirium symptoms (B =.12, p =.02) and worsened depressive symptoms (B =.10, p =.01). The findings suggested that targeting interventions to modifiable contextual elements and unit-level quality improvement will be promising.