Field test results are reported for the Observable Indicators of Nursing Home Care Quality Instrument-Assisted Living Version, an instrument designed to measure the quality of care in assisted living facilities after a brief 30-minute walk-through. The OIQ-AL was tested in 207 assisted living facilities in two states using Classical Test Theory, Generalizability Theory, and exploratory factor analysis.

Rantz, M.J., Aud, M.A., Zwygart-Stauffacher, M., Mehr, D.R., Petroski, G.F., Owen, S.V., Madsen, R.W., Flesner, M., Conn, V., & Maas, M. (2008). Field testing, refinement, and psychometric evaluation of a new measure of quality of care for assisted livingJournal of Nursing Measurement, 16(1), 16-30.

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The article discusses the initiative to measure the quality improvement efforts in assisted living facilities in the U.S. In 33,000 assisted living centers, there are roughly 800,000 residents who are under their care. However, there are continuing research to determine the efficient services offered in nursing homes to assist facilities in developing their care quality and to provide consumers with guidance.

Aud M., Rantz, M.J., Zwygart-Stauffacher M., Flesner M. (2007). Measuring quality of care in assisted living: A new tool for providers, consumers, and researchersJournal of Nursing Care Quality, 22(1), 4-7.

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The primary aim of this NINR-NIH–funded field test in 407 nursing homes in 3 states was to complete the development of and conduct psychometric testing for the Observable Indicators of Nursing Home Care Quality Instrument (Observable Indicators, OIQ). The development of the OIQ was based on extensive qualitative and iterative quantitative work that described nursing home care quality and did initial validity and reliability field testing of the instrument in 123 nursing homes in 1 state. The scale is meant for researchers, consumers, and regulators interested in directly observing and quickly evaluating (within 30 minutes of observation) the multiple dimensions of care quality in nursing homes. After extensive testing in this study, the Observable Indicators instrument has been reduced to 30 reliable and discriminating items that have a conceptually coherent hierarchical factor structure that describes nursing home care quality. Seven first-order factors group together into two second-order factors of Structure (includes Environment: Basics and Odors) and Process (includes Care Delivery, Grooming, Interpersonal Communication, Environment: Access, and Environment: Homelike) that are classic constructs of Quality, which was the third-order factor. Internal consistency reliability for the 7 first-order factors ranged from .77 to .93. Construct validity analyses revealed an association between survey citations and every subscale as well as the total score of the OIQ instrument. Known groups analysis revealed expected trends in the OIQ scores. The Observable Indicators instrument as a whole shows acceptable interrater and test-retest reliabilities, and strong internal consistency.
Scale subscales show acceptable reliability as well. Generalizability Theory analyses revealed that dependability of scores can be improved by including a second site observer, or by revisiting a site. There is a small additional benefit from increasing observers or visits beyond two.

Rantz, M. J., M. Zwygart-Stauffacher, D. R. Mehr, G. F. Petroski, S. V. Owen, R. W. Madsen, M. Flesner, V. Conn, J. Bostick, R. Smith, and M. Maas. 2006. Field testing, refinement, and psychometric evaluation of a new measure of nursing home care quality. Journal of Nursing Measurement 14(2):129–148.

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The primary aim of this NINR-NIH-funded field test in 407 nursing homes in 3 states was to complete the development of and conduct psychometric testing for the Observable Indicators of Nursing Home Care Quality Instrument (Observable Indicators, OIQ). The development of the OIQ was based on extensive qualitative and iterative quantitative work that described nursing home care quality and did initial validity and reliability field testing of the instrument in 123 nursing homes in 1 state. The scale is meant for researchers, consumers, and regulators interested in directly observing and quickly evaluating (within 30 minutes of observation) the multiple dimensions of care quality in nursing homes. After extensive testing in this study, the Observable Indicators instrument has been reduced to 30 reliable and discriminating items that have a conceptually coherent hierarchical factor structure that describes nursing home care quality. Seven first-order factors group together into two second-order factors of Structure (includes Environment: Basics and Odors) and Process (includes Care Delivery, Grooming, Interpersonal Communication, Environment: Access, and Environment: Homelike) that are classic constructs of Quality, which was the third-order factor. Internal consistency reliability for the 7 first-order factors ranged from .77 to .93. Construct validity analyses revealed an association between survey citations and every subscale as well as the total score of the OIQ instrument. Known groups analysis revealed expected trends in the OIQ scores. The Observable Indicators instrument as a whole shows acceptable interrater and test-retest reliabilities, and strong internal consistency. Scale subscales show acceptable reliability as well. Generalizability Theory analyses revealed that dependability of scores can be improved by including a second site observer, or by revisiting a site. There is a small additional benefit from increasing observers or visits beyond two.

Rantz, M., Zwygart-Stauffacher, M., Mehr, D., Petroski, G., Owen, S., & Madsen, R. (2006). Field testing, refinement and psychometric evaluation of a new measure of nursing home care qualityJournal of Nursing Measurement, 14(2), 129-148.

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Over the past 12 years, members of the Minimum Data Set (MDS) and Quality Research Team at the University of Missouri-Columbia have been working with the Missouri Department of Health and Senior Services to improve care in Missouri nursing homes. The team conducted initial qualitative studies that explored the multidimensional aspects of quality of nursing home care. Using grounded theory methods, dimensions important to consumers and overlapping dimensions important to providers, healthcare professionals, and regulators were identified. The quality dimensions were operationalized in a theoretical model of quality of nursing home care. We learned from the studies that quality of care in nursing homes is a concept that encompasses broad dimensions of not only technical care provided but also the context or environment in which the care is delivered.

Rantz, M.J., Zwygart-Stauffacher, M., & Flesner, M. (2005). Advances in measuring quality of care in nursing homes: a new tool for providers, consumers, regulators, and researchersJournal of Nursing Care Quality, 20(4), 293-296.

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This exploratory study was undertaken to discover the defining dimensions of nursing home care quality from the viewpoint of consumers of nursing home care. Eleven focus groups were conducted in five Missouri communities. The seven dimensions of the consumer multidimensional model of nursing home care quality are: staff, care, family involvement, communication, environment, home, and cost. The views of consumers and families are compared with the results of a previous study of providers of nursing home services. An integrated, multidimensional theoretical model is presented for testing and evaluation. An instrument based on the model is being tested to observe and score the dimensions of nursing home care quality.

While much is written about the topic of nursing home care quality, little attention is paid to carefully defining it or developing a theoretical model of the dimensions of nursing home care quality. Rantz and colleagues proposed a multidimensional theoretical model of nursing home care quality based on research with experienced providers. This second exploratory study was undertaken to discover the defining dimensions of nursing home care quality from the perspectives of consumers, to propose a conceptual model that integrates the views of both providers and consumers of nursing home care to guide nursing home quality research, and to develop instruments to measure nursing home care quality based on the integrated model.

Rantz, M. J., Zwygart-Stauffacher, M., Popejoy, L., Grando, V., Mehr, D., Hicks, L., Conn, V., Wipke-Tevis, D., Porter, R., Bostick, J., & Maas, M. (1999). Nursing home care quality: A multidimensional theoretical model integrating the views of consumers and providers. Journal of Nursing Care Quality, 14(1), 16-37.

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This exploratory study was undertaken to discover the defining dimensions of nursing home care quality and to propose a conceptual model to guide nursing home quality research and the development of instruments to measure nursing home care quality. Three focus groups were conducted in three central Missouri communities. A naturalistic inductive analysis of the transcribed content was completed. Two core variables (interaction and odor) and several related concepts emerged from the data. Using the core variables, related concepts, and detailed descriptions from participants, three models of nursing home care quality emerged from the analysis: (1) a model of a nursing home with good quality care; (2) a model of a nursing home with poor quality care; and (3) a multidimensional model of nursing home care quality. The seven dimensions of the multidimensional model of nursing home care quality are: central focus, interaction, milieu, environment, individualized care, staff, and safety. To pursue quality, the many dimensions must be of primary concern to nursing homes. We are testing an instrument based on the model to observe and score the dimensions of nursing home care quality.

Rantz, M. J., Mehr, D., Popejoy, L., Zwygart-Stauffacher, M., Hicks, L., Grando, V., Conn, V., Porter, R., Scott, J., & Maas, M. (1998). Nursing home care quality: A multidimensional theoretical model. Journal of Nursing Care Quality, 12(3), 30-46.

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