National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (2)
- Adverse Events (1)
- Antibiotics (6)
- Antimicrobial Stewardship (4)
- Cardiovascular Conditions (1)
- Caregiving (2)
- Care Management (3)
- Case Study (1)
- Catheter-Associated Urinary Tract Infection (CAUTI) (6)
- Children/Adolescents (8)
- Chronic Conditions (2)
- Communication (1)
- Critical Care (1)
- Data (1)
- Dementia (4)
- Diagnostic Safety and Quality (1)
- Digestive Disease and Health (1)
- Disparities (1)
- Elderly (25)
- Evidence-Based Practice (3)
- Falls (1)
- Guidelines (1)
- Healthcare-Associated Infections (HAIs) (10)
- Healthcare Costs (2)
- Healthcare Utilization (1)
- Health Information Technology (HIT) (1)
- Health Services Research (HSR) (2)
- Home Healthcare (1)
- Hospital Discharge (4)
- Hospitalization (4)
- Hospitals (3)
- Infectious Diseases (1)
- Influenza (1)
- Injuries and Wounds (5)
- (-) Long-Term Care (52)
- Medical Errors (1)
- Medicare (4)
- Medication (9)
- Medication: Safety (2)
- Men's Health (1)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (1)
- Neurological Disorders (3)
- Nursing (1)
- Nursing Homes (39)
- Nutrition (1)
- Obesity (1)
- Opioids (3)
- Outcomes (2)
- Pain (3)
- Patient-Centered Outcomes Research (3)
- Patient and Family Engagement (1)
- Patient Experience (1)
- Patient Safety (17)
- Payment (1)
- Policy (1)
- Practice Patterns (3)
- Prevention (7)
- Primary Care (1)
- Provider (2)
- Provider: Health Personnel (1)
- Provider: Nurse (1)
- Provider Performance (1)
- Quality Improvement (1)
- Quality Indicators (QIs) (1)
- Quality Measures (2)
- Quality of Care (5)
- Racial and Ethnic Minorities (1)
- Respiratory Conditions (2)
- Risk (4)
- Sepsis (1)
- Shared Decision Making (1)
- Skin Conditions (1)
- Sleep Problems (1)
- Stroke (1)
- Transitions of Care (5)
- Urinary Tract Infection (UTI) (5)
- Workforce (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 52 Research Studies DisplayedBurgermaster M, Murray M, Saiman L
Associations between enteral nutrition and acute respiratory infection among patients in New York metropolitan region pediatric long-term care facilities.
This study investigated the outcomes of children and a subsample of infants in pediatric long-term care facilities are need enteral nutrition (EN). Those patients who need EN had a higher risk of acute pediatric infection (ARI) and a lower odds of discharge than those who did not. Infants had a particular higher risk of comorbidities and infections when they were fed using percutaneous feeding tubes.
AHRQ-funded; HS021470.
Citation: Burgermaster M, Murray M, Saiman L .
Associations between enteral nutrition and acute respiratory infection among patients in New York metropolitan region pediatric long-term care facilities.
Nutr Clin Pract 2018 Dec;33(6):865-71. doi: 10.1002/ncp.10017..
Keywords: Children/Adolescents, Healthcare-Associated Infections (HAIs), Nutrition, Outcomes, Patient-Centered Outcomes Research, Patient Safety, Respiratory Conditions, Long-Term Care
Felix HC, Bradway C, Bird TM
Safety of obese persons in nursing homes.
This paper discusses the emergence of obese persons as a vulnerable group in the nursing home community. The authors discuss the special needs of this population including that obese residents require special protocols, trained staff, and appropriately sized equipment to prevent and treat skin breakdown.
AHRQ-funded; HS025703.
Citation: Felix HC, Bradway C, Bird TM .
Safety of obese persons in nursing homes.
Med Care 2018 Dec;56(12):1032-34. doi: 10.1097/mlr.0000000000000997..
Keywords: Long-Term Care, Obesity, Nursing Homes, Patient Safety, Skin Conditions
McConeghy KW, Lee Y, Zullo AR
Influenza illness and hip fracture hospitalizations in nursing home residents: are they related?
In this retrospective cohort study, the investigators evaluated the association between influenza and hip fracture hospitalizations in long-stay (LS) nursing home (NH) residents. The study authors found that influenza like illness (ILI) hospitalizations were associated with a 13% average increase in hip fracture hospitalization risk. In a given NH week, an increase in the number ILI hospitalizations from none to two was associated with an approximate one percentage point increase in hip fracture hospitalization risk.
AHRQ-funded; HS022998.
Citation: McConeghy KW, Lee Y, Zullo AR .
Influenza illness and hip fracture hospitalizations in nursing home residents: are they related?
J Gerontol A Biol Sci Med Sci 2018 Nov 10;73(12):1638-42. doi: 10.1093/gerona/glx200..
Keywords: Elderly, Injuries and Wounds, Hospitalization, Influenza, Long-Term Care, Nursing Homes
Makam AN, Nguyen OK, Kirby B
Effect of site-neutral payment policy on long-term acute care hospital use.
The purpose of this study was to assess the projected effect of the Centers for Medicare and Medicaid Services new site-neutral payment policy, which aims to decrease unnecessary long-term acute care hospital (LTACH) admissions by reducing reimbursements for less-ill individuals by 2020. The investigators concluded that the site-neutral payment policy may limit LTACH access in existing LTAC-scarce markets, with potential adverse implications for recovery of hospitalized older adults.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK, Kirby B .
Effect of site-neutral payment policy on long-term acute care hospital use.
J Am Geriatr Soc 2018 Nov;66(11):2104-11. doi: 10.1111/jgs.15539..
Keywords: Policy, Hospitalization, Payment, Long-Term Care, Healthcare Costs, Medicare, Elderly, Hospitals
Wilmont S, Hessels AJ, Kelly AM
Family experiences and perspectives on infection prevention in pediatric long-term care.
The aims of this qualitative study were to (a) explore perspectives on infection prevention among families visiting children in pediatric long-term care facilities and (b) identify facilitators of and barriers to optimal hand hygiene using semistructured in-depth interviews with 10 family members visiting two New York City metropolitan area facilities.
AHRQ-funded; HS021470.
Citation: Wilmont S, Hessels AJ, Kelly AM .
Family experiences and perspectives on infection prevention in pediatric long-term care.
Children/Adolescents, Healthcare-Associated Infections, Long-term Care, Pediatrics, Prevention Practices.
Keywords: Children/Adolescents, Healthcare-Associated Infections (HAIs), Long-Term Care, Prevention, Patient Safety
Makam AN, Nguyen OK, Xuan L
Long-term acute care hospital use of non-mechanically ventilated hospitalized older adults.
In this observational cohort study, the investigators sought to determine why non-mechanically ventilated hospitalized older adults are transferred to long-term acute care (LTAC) hospitals rather than remaining in the hospital. The authors found that nearly half of the variation in LTAC use is independent of illness severity and is explained by which hospital and what region the individual was hospitalized in.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK, Xuan L .
Long-term acute care hospital use of non-mechanically ventilated hospitalized older adults.
J Am Geriatr Soc 2018 Nov;66(11):2112-19. doi: 10.1111/jgs.15564..
Keywords: Elderly, Hospitalization, Long-Term Care, Respiratory Conditions
Hessels AJ, Murray MT, Cohen B
Perception of patient safety culture in pediatric long-term care settings.
Patient safety culture (PSC) is an emerging construct in adult long-term care settings. No measures are validated to quantify PSC in pediatric long-term care (pLTC) settings despite the importance of safety for this vulnerable population. The objectives of this study were to (1) describe PSC in pLTC; (2) assess the relationship of PSC to facility recommendation and overall safety rating; and (3) test the stability and reliability of the PSC survey over time.
AHRQ-funded; HS021470.
Citation: Hessels AJ, Murray MT, Cohen B .
Perception of patient safety culture in pediatric long-term care settings.
J Healthc Qual 2018 Nov/Dec;40(6):384-91. doi: 10.1097/jhq.0000000000000134..
Keywords: Children/Adolescents, Long-Term Care, Patient Safety, Children/Adolescents
D'Agata EMC, Varu A, Geffert SF
Acquisition of multidrug-resistant organisms in the absence of antimicrobials.
This nested case-control study was conducted among 137 nursing home residents who did not receive antimicrobials, with 44 acquiring a multi-drug resistant organism. Risk factors identified included receiving gastrointestinal medication that affected the gut microbiome, the number of visits from healthcare workers, pressure ulcers, and not residing in a dementia unit.
AHRQ-funded; HS021666.
Citation: D'Agata EMC, Varu A, Geffert SF .
Acquisition of multidrug-resistant organisms in the absence of antimicrobials.
Clin Infect Dis 2018 Oct 15;67(9):1437-40. doi: 10.1093/cid/ciy358..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Nursing Homes, Long-Term Care, Elderly, Digestive Disease and Health, Case Study
Goodwin JS, Li S, Middleton A
Differences between skilled nursing facilities in risk of subsequent long-term care placement.
The objective of this study was to determine how the risk of subsequent long-term care (LTC) placement varied between skilled nursing facilities (SNFs) and the SNF characteristics associated with this risk. The investigators concluded that risk of subsequent LTC placement, an important and negatively viewed outcome for older adults, varied substantially between SNFs. Individuals in higher-quality SNFs were at lower risk.
AHRQ-funded; HS022134.
Citation: Goodwin JS, Li S, Middleton A .
Differences between skilled nursing facilities in risk of subsequent long-term care placement.
J Am Geriatr Soc 2018 Oct;66(10):1880-86. doi: 10.1111/jgs.15377..
Keywords: Nursing Homes, Long-Term Care, Elderly, Medicare
Berridge C, Mor V
Disparities in the prevalence of unmet needs and their consequences among black and white older adults.
This study documents differential prevalence of need for assistance with personal, instrumental, and mobility tasks and adverse consequences of unmet needs, nursing home relocation, and mortality among Black and White older adults.
AHRQ-funded; HS000011.
Citation: Berridge C, Mor V .
Disparities in the prevalence of unmet needs and their consequences among black and white older adults.
J Aging Health 2018 Oct;30(9):1427-49. doi: 10.1177/0898264317721347..
Keywords: Elderly, Disparities, Racial and Ethnic Minorities, Nursing Homes, Long-Term Care
Joyce NR, McGuire TG, Bartels SJ
The impact of dementia special care units on quality of care: an instrumental variables analysis.
The purpose of this study was to compare the quality of care following admission to a nursing home (NH) with and without a dementia special care unit (SCU) for residents with dementia. The investigators found that facilities with an SCU provided better quality of care as measured by several validated quality indicators. The authors suggested that given the aging population, policies to promote the expansion and use of dementia SCUs may be warranted.
AHRQ-funded; HS022998.
Citation: Joyce NR, McGuire TG, Bartels SJ .
The impact of dementia special care units on quality of care: an instrumental variables analysis.
Health Serv Res 2018 Oct;53(5):3657-79. doi: 10.1111/1475-6773.12867..
Keywords: Dementia, Elderly, Quality of Care, Long-Term Care, Nursing Homes
Bradley SM, Schweon SJ, Mody L
Identifying safe practices for use of the urinary leg bag drainage system in the postacute and long-term care setting: an integrative review.
In the postacute and long-term care setting, the practice of changing the indwelling urinary catheter large sterile drainage bag to a small-size leg drainage bag is intended to maintain a person's mobility, dignity, and comfort. There is scant evidence that assesses the impact of intermittent use of a leg bag on frequency of urinary tract infection since this breaks the closed urinary drainage system. The investigators identified the existence of low-level evidence that leg bags pose no evident, disproportionate risk of infection compared with maintaining a closed system.
AHRQ-funded; 290201000025I.
Citation: Bradley SM, Schweon SJ, Mody L .
Identifying safe practices for use of the urinary leg bag drainage system in the postacute and long-term care setting: an integrative review.
Am J Infect Control 2018 Sep;46(9):973-79. doi: 10.1016/j.ajic.2018.03.029..
Keywords: Care Management, Evidence-Based Practice, Healthcare-Associated Infections (HAIs), Long-Term Care, Patient Safety, Urinary Tract Infection (UTI)
Alexander GL, Madsen R
A national report of nursing home quality and information technology: two-year trends.
The authors sought to answer these two research questions: What are the trends in information technology (IT) adoption in US nursing home facilities over 2 years? How are 2-year trends in IT adoption in US nursing homes related to nationally reported quality measures (QMs)? Using surveys of nursing home administrators and data from Nursing Home Compare, they concluded that multiple dimensions of IT sophistication influence QMs in every health care domain, providing an opportunity to design a reporting system that joins these important variables to be assessed on a national scale.
AHRQ-funded; HS022497.
Citation: Alexander GL, Madsen R .
A national report of nursing home quality and information technology: two-year trends.
J Nurs Care Qual 2018 Jul/Sep;33(3):200-07. doi: 10.1097/ncq.0000000000000328.
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Keywords: Health Information Technology (HIT), Nursing Homes, Long-Term Care, Quality of Care, Quality Measures, Provider Performance
Krein SL, Greene MT, King B
Assessing a national collaborative program to prevent catheter-associated urinary tract infection in a Veterans Health Administration nursing home cohort.
Collaborative programs have helped reduce catheter-associated urinary tract infection (CAUTI) rates in community-based nursing homes. This study assessed whether collaborative participation produced similar benefits among Veterans Health Administration (VHA) nursing homes. The researchers found that no changes in CAUTI rates, catheter use, or urine culture orders were found during the program period. One potential reason was the relatively low baseline CAUTI rate, as compared with a cohort of community-based nursing homes.
AHRQ-funded; 290201000025I.
Citation: Krein SL, Greene MT, King B .
Assessing a national collaborative program to prevent catheter-associated urinary tract infection in a Veterans Health Administration nursing home cohort.
Infect Control Hosp Epidemiol 2018 Jul;39(7):820-25. doi: 10.1017/ice.2018.99..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Long-Term Care, Nursing Homes, Patient Safety, Prevention, Urinary Tract Infection (UTI)
Sloane PD, Ward K, Weber DJ
Can sepsis be detected in the nursing home prior to the need for hospital transfer?
The purpose of this study was to determine whether and to what extent simple screening tools might identify nursing home (NH) residents who are at high risk of becoming septic. The authors concluded that NHs need better systems to monitor NH residents whose status is changing, and to present that information to medical providers in real time, either through rapid medical response programs or telemetry.
AHRQ-funded; HS022846.
Citation: Sloane PD, Ward K, Weber DJ .
Can sepsis be detected in the nursing home prior to the need for hospital transfer?
J Am Med Dir Assoc 2018 Jun;19(6):492-96.e1. doi: 10.1016/j.jamda.2018.02.001..
Keywords: Sepsis, Nursing Homes, Long-Term Care, Diagnostic Safety and Quality, Elderly
Smith SN, Greene MT, Mody L
Evaluation of the association between Nursing Home Survey on Patient Safety culture (NHSOPS) measures and catheter-associated urinary tract infections: results of a national collaborative.
The investigators examined the association between nursing home safety culture, measured with the Nursing Home Survey on Patient Safety Culture (NHSOPS), and catheter-associated urinary tract infection rates (CAUTI) using data from a recent national collaborative for preventing healthcare-associated infections in nursing homes. They found that this large national collaborative of nursing homes saw declining CAUTI rates as well as improvements in several NHSOPS domains. However, no association was found between initial or over-time NHSOPS scores and CAUTI rates.
AHRQ-funded; 290201000025I.
Citation: Smith SN, Greene MT, Mody L .
Evaluation of the association between Nursing Home Survey on Patient Safety culture (NHSOPS) measures and catheter-associated urinary tract infections: results of a national collaborative.
BMJ Qual Saf 2018 Jun;27(6):464-73. doi: 10.1136/bmjqs-2017-006610.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Long-Term Care, Nursing Homes, Patient Safety, Quality Measures, Urinary Tract Infection (UTI)
Murray MT, Johnson CL, Cohen B
Use of antibiotics in paediatric long-term care facilities.
The authors sought to describe antibiotic use in three pediatric long-term care (LTC) facilities and to describe the factors associated with use. They found that the use of antibiotics in pediatric LTC facilities is widespread. They recommended further assessment of antibiotic use in pediatric LTC facilities.
AHRQ-funded; HS021470.
Citation: Murray MT, Johnson CL, Cohen B .
Use of antibiotics in paediatric long-term care facilities.
J Hosp Infect 2018 Jun;99(2):139-44. doi: 10.1016/j.jhin.2017.10.019.
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Keywords: Antibiotics, Children/Adolescents, Healthcare-Associated Infections (HAIs), Long-Term Care, Practice Patterns
Jones CD, Burke RE
Inpatient notes - getting past the "black box"-opportunities for hospitalists to improve postacute care transitions.
The care provided after hospital discharge in skilled-nursing facilities and home health care is collectively termed postacute care (PAC). In this article, the authors outline 3 key problems with postacute care transitions and offer potential solutions.
AHRQ-funded; HS024569.
Citation: Jones CD, Burke RE .
Inpatient notes - getting past the "black box"-opportunities for hospitalists to improve postacute care transitions.
Ann Intern Med 2018 May 15;168(10):HO2-HO3. doi: 10.7326/m18-0940..
Keywords: Health Services Research (HSR), Home Healthcare, Hospital Discharge, Long-Term Care, Transitions of Care
Berry SD, Zullo AR, Lee Y
Fracture Risk Assessment in Long-term Care (FRAiL): development and validation of a prediction model.
This paper’s objective was to develop and validate a model, Fracture Risk Assessment in Long-term Care (FRAiL) to predict the 2-year risk of hip fracture in nursing home (NH) residents using readily available clinical characteristics. The FRAiL model was developed specifically to identify NH residents at greatest risk for hip fracture, and results identified a different pattern of risk factors compared with community models. This practical model could be used to screen NH residents for fracture risk and to target intervention strategies.
AHRQ-funded; HS022998.
Citation: Berry SD, Zullo AR, Lee Y .
Fracture Risk Assessment in Long-term Care (FRAiL): development and validation of a prediction model.
J Gerontol A Biol Sci Med Sci 2018 May 9;73(6):763-69. doi: 10.1093/gerona/glx147.
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Keywords: Elderly, Injuries and Wounds, Long-Term Care, Nursing Homes, Risk
McCreedy E, Loomer L, Palmer JA
Representation in the care planning process for nursing home residents with dementia.
This study examined the participation of residents, family members, or representatives in nursing home (NH) long-term care planning for residents with cognitive impairment. A large for-profit NH system was used to recruit study participants. A sample of 18,552 long-stay NH residents in 2016 were surveyed. Of residents with no cognitive impairment, 8% had family or representative participation in care planning, compared with 26% of residents with severe impairments. Family participation was greater in NHs with more social workers.
AHRQ-funded; HS000011.
Citation: McCreedy E, Loomer L, Palmer JA .
Representation in the care planning process for nursing home residents with dementia.
J Am Med Dir Assoc 2018 May;19(5):415-21. doi: 10.1016/j.jamda.2018.01.004..
Keywords: Dementia, Nursing Homes, Long-Term Care, Patient and Family Engagement, Neurological Disorders
Dore DD, Zullo AR, Mor V
Age, sex, and dose effects of nonbenzodiazepine hypnotics on hip fracture in nursing home residents.
This study examined the rate of hip fracture in nursing home residents prescribed nonbenzodiazepine hypnotics. A sample of nursing home residents was used and linked to Medicare and Minimum Data Set (2007-2008) data. The rate of hip fracture was higher in residents aged 90 and above, and lower in residents 70 or below. There was no different by sex.
AHRQ-funded; HS022998.
Citation: Dore DD, Zullo AR, Mor V .
Age, sex, and dose effects of nonbenzodiazepine hypnotics on hip fracture in nursing home residents.
J Am Med Dir Assoc 2018 Apr;19(4):328-32.e2. doi: 10.1016/j.jamda.2017.09.015..
Keywords: Injuries and Wounds, Medication, Nursing Homes, Long-Term Care, Adverse Drug Events (ADE), Adverse Events, Falls, Risk, Patient Safety
Li S, Middleton A, Ottenbacher KJ
Trajectories over the first year of long-term care nursing home residence.
This retrospective cohort study examined changes in situation for Medicare fee-for-service beneficiaries newly admitted to long-term nursing homes from July 2012 to December 2013 for the first year after admission. Data was used from the Minimum Data Set and Medicare Provider and Analysis Reviews claims data. Median length of stay in long-term care was 127 days, and for any institution 158 days. At 12 months post admission, 35% had died, 36.9% remained in long-term care, 23.4% were in the community, and 4.7% were in acute care hospitals or other institutions.
AHRQ-funded; HS022134.
Citation: Li S, Middleton A, Ottenbacher KJ .
Trajectories over the first year of long-term care nursing home residence.
J Am Med Dir Assoc 2018 Apr;19(4):333-41. doi: 10.1016/j.jamda.2017.09.021.
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Keywords: Long-Term Care, Nursing Homes, Elderly, Medicare, Patient-Centered Outcomes Research, Outcomes
Larson EL, Murray MT, Cohen B
Behavioral interventions to reduce infections in pediatric long-term care facilities: the keep it clean for kids trial.
Researchers examined the success of behavioral interventions to reduce infections in pediatric long-term care facilities. The intervention, called Keep it Clean for Kids, included leadership commitment, frequent hand-washing, and electronic monitoring of hand hygiene. Improvements were show in infection reduction in two sites, fewer hospitalizations in all sites, and varied outcomes in the number of outbreaks/cases.
AHRQ-funded; HS021470.
Citation: Larson EL, Murray MT, Cohen B .
Behavioral interventions to reduce infections in pediatric long-term care facilities: the keep it clean for kids trial.
Behav Med 2018 Apr-Jun;44(2):141-50. doi: 10.1080/08964289.2017.1288607..
Keywords: Children/Adolescents, Long-Term Care, Healthcare-Associated Infections (HAIs), Patient Safety, Prevention
Jump RLP, Crnich CJ, Mody L
Infectious diseases in older adults of long-term care facilities: update on approach to diagnosis and management.
The diagnosis, treatment, and prevention of infectious diseases in older adults in long-term care facilities (LTCFs), particularly nursing facilities, remains a challenge for all health providers who care for this population. This review provides updated information on the currently most important challenges of infectious diseases in LTCFs. With the increasing prescribing of antibiotics in older adults, particularly in LTCFs, the topic of antibiotic stewardship is presented in this review.
AHRQ-funded; HS022465.
Citation: Jump RLP, Crnich CJ, Mody L .
Infectious diseases in older adults of long-term care facilities: update on approach to diagnosis and management.
J Am Geriatr Soc 2018 Apr;66(4):789-803. doi: 10.1111/jgs.15248.
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Keywords: Elderly, Healthcare-Associated Infections (HAIs), Infectious Diseases, Nursing Homes, Long-Term Care, Antimicrobial Stewardship, Antibiotics, Medication, Evidence-Based Practice, Guidelines
Berridge C, Tyler DA, Miller SC
Staff empowerment practices and CNA retention: findings from a nationally representative nursing home culture change survey.
This article examines whether staff empowerment practices common to nursing home culture change are associated with certified nursing assistant (CNA) retention. It concluded that after adjustment for covariates, a greater staff empowerment practice score was positively associated with greater retention. Compared with the low empowerment category, nursing homes with scores in the medium category had a 44 percent greater likelihood of having higher CNA retention.
AHRQ-funded; HS000011.
Citation: Berridge C, Tyler DA, Miller SC .
Staff empowerment practices and CNA retention: findings from a nationally representative nursing home culture change survey.
J Appl Gerontol 2018 Apr;37(4):419-34. doi: 10.1177/0733464816665204.
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Keywords: Long-Term Care, Nursing Homes, Provider, Provider: Health Personnel, Workforce