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Care Planning Integrity in Nursing Facilities

Taunton, Roma Lee; Piamjariyakul, Ubolrat; Gajewski, Byron; Lee, Robert H.; Bott, Marjorie J.

doi: 10.1097/01.NNR.0000313493.79659.8f

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.

Roma Lee Taunton, PhD, RN, FAAN, is Professor Emerita, School of Nursing; Ubolrat Piamjariyakul, PhD, RN, is Research Associate, School of Nursing; Byron Gajewski, PhD, is Associate Professor, School of Allied Health; Robert H. Lee, PhD, is Associate Professor, Health Policy and Management Department, School of Medicine; and Marjorie J. Bott, PhD, RN, is Associate Dean, Research, School of Nursing, University of Kansas Medical Center.

Editor's Note Additional information provided by the authors expanding this article is on the Editor's Web site at

Accepted for publication March 31, 2008.

The study reported in this article is part of a larger project, Care Planning Integrity & Nursing Home Resident Outcomes, supported by Grant 5RO1 NR008028 that is funded by the National Institute of Nursing Research to the University of Kansas School of Nursing and to Roma Lee Taunton, PhD, RN, FAAN, principal investigator.

Thank you to the care planning team members and other staff at the participating nursing homes who provided the primary data for this research. Thank you also to Linda Adams-Wendling, PhD, RN, CNHA, associate professor, Emporia State University Newman Division of Nursing; Nancy Dunton, PhD, associate professor, University of Kansas School of Nursing; Katy Nguyen, RN, clinical consultant, Minimum Data Set for Resident Assessment and Care Screening and quality research team, University of Missouri School of Nursing; and Daniel L. Swagerty, MD, MPH, professor, University of Kansas School of Medicine, for their invaluable contributions in the conceptualization and early phases of the project. Thank you to Valorie Coffland, Mary Lucas, Katie Luna, Patricio Padilla, and Sara Pedram for their dedication and diligence in data collection.

Corresponding author: Roma Lee Taunton, PhD, RN, FAAN, School of Nursing, University of Kansas, Mail Stop 4043, 3901 Rainbow Blvd., Kansas City, KS 66160 (e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.