Shawna M McDonald

University of California, San Francisco, San Francisco, CA, United States

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Publications (6)5.07 Total impact

  • Laura M Wagner, Shawna M McDonald, Nicholas G Castle
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    ABSTRACT: PURPOSE: To examine accreditation from nursing homes accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) and whether this is associated with improved rehabilitation care. DESIGN: Cross-sectional association of CARF accreditation and quality. METHODS: Comparison of the short-stay quality measures (influenza and pneumococcal vaccination; pain; delirium; pressures sores; five-star quality and health inspection scores) between the sample of 246 CARF-accredited homes compared with the 15,393 nursing homes in the 2010 On-Line Survey Certification of Automated Records (OSCAR). FINDINGS: CARF-accredited nursing homes demonstrate better quality with regard to the short-stay quality measures. CONCLUSIONS: Approaches beyond traditional regulation and governmental inspections are necessary to improve the quality of care in nursing homes. CLINICAL RELEVANCE: During a patient's rehabilitation stay, minimizing iatrogenic complications is paramount. Given the findings of this study, it is unfortunate that very few nursing homes are CARF accredited.
    Rehabilitation nursing: the official journal of the Association of Rehabilitation Nurses 05/2013; · 0.78 Impact Factor
  • Shawna M McDonald, Laura M Wagner, Nicholas G Castle
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    ABSTRACT: There is evidence that staffing characteristics influence quality of care in nursing homes. Federal and state surveyors conduct inspections of homes to assess their compliance with regulatory standards, including requirements related to staffing. Deficiency citations are issued when these standards are not met. This article examines the relationship between operational, facility, and market characteristics and organizational performance measured as staffing-related deficiency citations. Online Survey Certification of Automated Records (OSCAR) data from 2000 through 2007 were used with multinomial logistic regression analyses to identify factors associated with deficiency citations for staffing. Chain members and facilities with poor quality of care were more likely to receive deficiency citations for staffing. Greater bed count and competition between nursing homes were associated with a decreased likelihood of deficiency citations for staffing. Staffing-related deficiencies within nursing homes vary according to various operational, facility, and market characteristics.
    Journal of Aging & Social Policy 01/2013; 25(1):83-97. · 0.60 Impact Factor
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    Laura M Wagner, Shawna M McDonald, Nicholas G Castle
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    ABSTRACT: Safety culture interventions in hospitals have been found to be associated with improved safety practices and outcomes. Studies in nursing homes generally report a poorly developed safety culture. Voluntary accreditation provides a structure for organizing care processes and is known to stimulate continuous quality improvement and thereby has the potential to stimulate improvements in organizational safety culture. The impact of Joint Commission accreditation on patient safety culture perceptions among senior managers in nursing homes in the United States was assessed. A random sample of 6,000 nursing homes was selected from all 50 states. The Nursing Home Survey on Resident Safety Culture was sent to these facilities, and nursing home administrators and directors of nursing were instructed to complete the survey. Scores were computed using the instrument agreement scale, in which the percentage of positive responses represented the summary score. Students' paired sample t-tests were used to compare differences in scores between respondents from accredited nursing homes and those from nonaccredited nursing homes. Multivariate analyses were then used to examine the association between accreditation and each resident safety culture (RSC) subscale, controlling for facility and market characteristics. The analytic response rate for the sample was 67%. After facility and market characteristics were controlled for, senior managers in accredited nursing homes rated 8 of the 11 RSC domains significantly higher. Joint Commission accreditation appeared to be associated with a more favorable RSC in nursing homes. Assessing a nursing home's RSC is an organization's first step toward improving the culture of safety. These findings support the need for further discussion and facilitation of voluntary accreditation in nursing homes.
    Joint Commission journal on quality and patient safety / Joint Commission Resources 05/2012; 38(5):207-15.
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    Laura M Wagner, Shawna M McDonald, Nicholas G Castle
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    ABSTRACT: This study examines the association between accreditation and select measures of quality in U.S. nursing homes, both cross-sectionally and over time. Data analyzed in this research originated from a web-based search of The Joint Commission (TJC) accredited facilities and the Nursing Home Compare set of Quality Measures relating to physical restraint use, pain management, urinary catheter use, and pressure sores. Five-Star Nursing Home Quality Rating System information was also used to calculate overall quality measure and health inspection scores. Data were analyzed using negative binomial regression. Comparing quality in the year before accreditation with the 1st year after accreditation, all five Quality Measures and both Five-Star categories demonstrated improvement. In comparing quality after 8 years of accreditation, three of the Quality Measures examined continued to improve. There were no cases where accreditation was associated with decreased quality. These results indicate that TJC accredited nursing homes improve their quality immediately after accreditation but do not continue to improve in all areas over time.
    Policy Politics &amp Nursing Practice 04/2012; 13(1):8-16.
  • Source
    Laura M Wagner, Shawna M McDonald, Nicholas G Castle
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    ABSTRACT:  This study examines the association between nursing home accreditation and deficiency citations.   Data originated from a web-based search of The Joint Commission (TJC) accreditation and On-line Survey Certification of Automated Records from 2002 to 2010. Deficiency citations were divided into 4 categories: resident behavior and facility practices, quality of life, quality of care, and the most severe citations. Data were analyzed through negative binomial regression, where the number of residents at risk for each measure was the exposure level for that measure.   TJC-accredited nursing homes had fewer deficiency citations in all 4 deficiency categories examined. Comparing citations in the year of accreditation with the first year after accreditation, 3 of the 4 deficiency categories were significant. In comparing deficiency citations after 8 years of accreditation, all 4 categories of deficiencies were significant. In all cases, accreditation was associated with fewer deficiency citations.   Our results indicate that TJC-accredited nursing homes improve their quality immediately after accreditation and continue to maintain these improvements over the long-term. These findings support the need for further discussion and facilitation of voluntary accreditation in nursing homes.
    The Gerontologist 03/2012; 52(4):561-70. · 2.48 Impact Factor
  • Laura M Wagner, Shawna M McDonald, Nicholas G Castle
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    ABSTRACT: This article examines whether nursing home facility-level characteristics are associated with the likelihood of receiving deficiency citations for physical restraints, including restrictive side rails. Data from the On-Line Survey Certification of Automated Records were used to calculate odds ratios for facility-level characteristics associated with these deficiency citations. Repeat records from 2000 to 2007 were combined to produce longitudinal data. The results of this study show that restraint/side rail deficiency citations were negatively associated with higher staffing levels of registered nurses and licensed practical nurses (p ≤ .001) and higher Medicaid reimbursement rates (p ≤ .01). Citations were positively associated with greater nurse aide staffing (p ≤ .01) and higher quality-of-care deficiency citation percentiles (p ≤ .001). The extent of physical restraint and restrictive side rail misuse within nursing homes appears to vary according to various facility characteristics. It is less clear how internal processes within a facility bring about these observed patterns of variation.
    Western Journal of Nursing Research 03/2012; · 1.22 Impact Factor

Publication Stats

8 Citations
5.07 Total Impact Points

Institutions

  • 2013
    • University of California, San Francisco
      • Department of Community Health Systems
      San Francisco, CA, United States
    • University of Toronto
      • Faculty of Medicine
      Toronto, Ontario, Canada
  • 2012
    • CUNY Graduate Center
      New York City, New York, United States
    • New York University
      New York City, New York, United States
    • City University of New York - York College
      New York City, New York, United States