Although there has been increased interest in using outcomes as measures of quality, few studies have shown a link between structure or process and outcomes. In this analysis, based on approximately 2,500 residents in 80 nursing homes in Rhode Island, multivariate models estimate which aspects of care are associated with resident outcomes after controlling for resident characteristics. Outcomes, measured over a 6-month period included death, functional decline, and functional improvement. Results suggest that higher staff levels and lower RN turnover were related to functional improvement. Facilities with high catheter use, low rates of skin care, and low participation in organized activities were associated with negative outcomes. Facilities with few private-pay residents were also associated with negative outcomes. Receipt of a serious federal citation was associated with improved outcomes. For-profit facilities appeared to be more efficient in use of resources.
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