Care planning integrity in nursing facilities.

Background: Although there is some evidence of improved quality in nursing home care after the implementation of the 1987 Omnibus Budget Reconciliation Act regulations, the nursing processes that contribute to that improvement are not well understood. Assumptions that the mandated tools for resident assessment and care planning account for the change remain uninvestigated.

Objectives: To generate an empirically supported conceptual model of care planning integrity, incorporating five subconstructs: coordination, integration, interdisciplinary team, restorative perspective, and quality.

Methods: A correlational, model generation-model selection design guided the study. Using a random sample of 107 facilities, the research team combined primary data collected from care planning team members (n = 508) via a telephone survey, with variables extracted from the Medicaid Cost Reports and the Centers for Medicaid and Medicare Services Online Survey, Certification, and Reporting System (OSCAR) database. Primary and alternative models of care planning integrity were examined for fit to the data using structural equation modeling procedures.

Results: Using preliminary analyses, 18 observed indicators to represent the five latent subconstructs were identified. Fit indices for the primary model were borderline (comparative fit index =.892; root mean square error of approximation = .048), but were excellent for the alternative model (comparative fit index = .972; root mean square error of approximation = .026). Care planning integrity is demonstrated within nursing facilities through direct relationships with coordination, integration, and quality, and indirect relationships through integration with interdisciplinary team and restorative perspective.

Discussion: Care planning integrity captures differences in the way nursing facilities implement the care planning process, using the mandated standardized tools, that may make a difference in resident outcomes. Subsequent research is indicated to address those dynamics.