ORGANIZATIONAL CONTEXT AND QUALITY INDICATORS IN NURSING HOMES: A MICROSYSTEM LOOK
Bibliographic record
Abstract
Abstract This cross-sectional quantitative sub-project assessed the association of organizational context (modifiable elements of work environments) with quality indicators (QIs) at the clinical microsystem (care unit) level. We used TREC data collected 09/2019-03/2020. The sample included 285 care units within 91 Western Canadian nursing homes. Outcomes included thirteen practice-sensitive QIs derived from the Minimum Data Set 2.0. Results from random-intercept logistic regression for each dichotomized QI showed that higher unit-aggregated scores on contextual elements as identified by the Alberta Context Tool, specifically care aide participation in decision-making (OR=3.7-8.4, p<.05), care aide perceived staffing (OR=2.6, p<.05) and time for completing tasks (OR=5.1-7.0, p<.05), and care aide rated unit-level leadership (OR=20.1, p<.05), were associated with a better unit-level performance on delirium symptoms, indwelling catheter use, behavioral symptoms, pain, and late-loss physical function. The findings suggest that targeting modifiable contextual elements is an important avenue for quality improvement interventions in nursing homes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".