Abstract
This article demonstrates how Bayesian networks can be employed as a tool to assess the quality of care in nursing homes. For the data sets analyzed, the proposed model performs comparably to existing quantitative assessment models. In addition, a Bayesian network approach offers several uniques advantages. The structure and parameters of a Bayesian network provide rich insight into the multidimensional aspects of the quality of care. Bayesian networks can be used as a guide in implementing limited resources by identifying information that would be most relevant to an assessment. Finally, Bayesian networks provide a straightforward framework for integrating nursing home care quality research that is conducted in various locations and for various purposes.
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References
Atchley S (1991) A time-ordered, systems approach to quality assurance in longterm care. J Appl Gerontol 10(1):19–34
Bøttcher S (2001) Learning bayesian networks with mixed variables. In Proceedings of the eighth international workshop in artificial intelligence and statistics, pp. 149–156
Bøttcher S, Dethlefsen C (2004) Deal: learning bayesian networks with mixed variables. R package version 1.2–22.
Castle N, Engbert J, Liu D (2007) Have nursing home compare quality measure scores changed over time in response to competition? Qual Saf Health Care 16:185–191
Center for Health Systems Research and Analysis (2001) QI definitions. [Online; accessed 12-April-2005; http://www.chsra.wisc.edu/CHSRA/PIP_ORYX_LTC/QI_Matrix/main.htm].
Chesteen S, Helgheim B, Randall T, Wardell D (2005) Comparing quality of care in non-profit and for-profit nursing homes: a process perspective. J Oper Manag 23(2):229–242
Donabedian, A. (1988) The quality of care: how can it be assessed? J Am Med Assoc 260(12):1743–1748
Geiger D, Heckerman D (1994) Learning gaussian networks. In Uncertainty in artificial intelligence; proceedings of the tenth conference
Goodson J (2005) Assessing the quality of care in nursing homes through bayesian belief networks. Master’s thesis, University of Missouri—Columbia
Gustafson D, Sainfort F, Konigsveld R, Zimmerman D (1990) Quality assessment index (QAI) for measuring nursing home quality. Health Serv Res 25(1):97–127
Harrington C, OMeara J, Kitchener M, Simon L, Schnelle J (2003) Designing a report card for nursing facilities: what information is needed and why. The Gerontologist 43(Special Issue II):47–57
Heckerman D, Geiger D, Chickering D (1995) Learning bayesian networks: the combination of knowledge and statistical data. Mach Learn 20:197–243
Hogg R, Craig A, McKean J (2004) Introduction to mathematical statistics. Prentice Hall.
Huang C, Darwiche A (1996) Inference in belief networks: a procedural guide. Int J Approx Reason 15(3):225–263
Institute of Medicine (1986) Improving the quality of care in nursing homes. National Academy Press
Institute of Medicine (1996) Nursing staff in hospitals and nursing homes: is it adequate? National Academy Press
Institute of Medicine (2000) Improving the quality of long-term care. Technical report
Jensen F (1996) An introduction to Bayesian networks. UCL Press Limited, London
Jensen F, Lauritzen S, Olesen K (1990) Bayesian updating in causal probabilistic networks by local computation. Computational Statistical Quarterly 4.
Karon S, Sainfort F, Zimmerman D (1999) Stability of nursing home quality indicators over time. Med. Care Res. Rev. 37(6):570–579
Mukamel D, Spector W, Zinn J, Huang L, Weimer D, Dozier A (2007) Nursing homes’ response to the nursing home compare report card. J Gerontol: Psychological Sciences 62:S218–S225
Pearl J (1988) Probabilistic reasoning in intelligent systems. Morgan Kaufmann, San Mateo, CA
Rantz M, Hicks L, Grando V, Petroski G, Madsen R, Mehr D, Conn V, Zwygart-Staffacher M, Scott J, Flesner M, Bostick J, Porter R, Maas M (2004) Nursing home quality, cost, staffing, and staff mix. The Gerontologist 44(1):24–38
Rantz M, Hicks L, Petroski G, Madsen R, Mehr D, Conn V, Zwygart-Staffacher M, Maas M (2004) Stability and sensitivity of nursing home quality indicators. J Gerontol 59A(1):79–82
Rantz M, Jensdottir A, Hjaltadottir I, Gudmundsdottir H, Gudjonsdottir J, Brunton B, Rook M (2002) International field test results of the observable indicators of nursing home care quality instrument. Int Nurs Rev 49(4):234–242
Rantz M, 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. J Nurs Care Qual 12(3):30–46
Rantz M, Petroski G, Madsen R, Mehr D, Popejoy L, Hicks L, Porter R, Zwygart-Stauffacher M, Grando V (2000) Setting thresholds for quality indicators dervied from MDS data for nursing home quality improvement reports: an update. Joint Comm J Qual Improv 26(2):101–110
Rantz M, Zwygart-Stauffacher M, Flesner M (2005) Advances in measuring quality of care in nursing homes. J Nurs Care Qual 20(4):293–296
Rantz M, Zwygart-Stauffacher M, Popejoy L, Grando V, Mehr D, Hicks L, Conn V, Wipke-Tevis D, Porter R, Bostick J, Maas M, Scott J (1999) Nursing home care quality: A multidimensional theoretical model integrating the views of consumers and providers. J Nurs Care Qual 14(1):16–37
Sainfort F, Ramsay J, Ferreira P, Mezghani L (1994) A first step in total quality management of nursing facility care: development of an empirical model of structure, process and outcome dimensions. Am J Med Qual 9(2):74–86
Sainfort F, Ramsay J, Monato H Jr (1995) Conceptual and methodological sources of variation in measurement of nursing home quality: an evaluation of 24 models and an empirical study. Med Care Res Rev 52(1):60–87
Spiegelhalter D, Dawid A, Lauritzen S, Cowell R (1993) Bayesian analysis in expert systems. Stat Sci 8(3):219–283
Ullmann S (1985) The impact of quality on cost in the provision of long-term care. Inquiry 22(3):293–302
Unruh L, Wan T (2004) A systems framework for evaluating nursing care quality in nursing homes. J Med Syst 28(2):197–213
Weech-Maldonado R, Neff G, Mor V (2003) Does quality of care lead to better financial performance?: the case of the nursing home industry. Health Care Manage Rev 28(3):201–216
Zimmerman D (2003) Improving nursing home quality of care through outcomes data: the mds quality indicators. Int J Geriatr Psychiatry 18(3):250–257
Acknowledgements
The authors wish to acknowledge the contributions of the University of Missouri-Columbia MDS and Nursing Home Quality Research Team. Research activities were partially supported by the National Institute of Nursing Research (NINR) 1R01NR/AG05287-01A2. Opinions are those of the authors and do not represent NINR.
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Goodson, J., Jang, W. Assessing nursing home care quality through Bayesian networks. Health Care Manage Sci 11, 382–392 (2008). https://doi.org/10.1007/s10729-008-9063-x
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DOI: https://doi.org/10.1007/s10729-008-9063-x