Conceptual and methodological sources of variation in the measurement of nursing facility quality: an evaluation of 24 models and an empirical study.

Whereas many researchers have developed sophisticated instruments to assess quality of care in nursing facilities (NFs), the concept of quality, its measurement, and its relationship to organizational characteristics remain important issues that are characterized by inconsistent findings across studies. The conceptualization and methodologies used in twenty-four NF quality studies are compared. The review identifies four main sources of variation hypothesized to be important bases of inconsistency in the NF quality literature: (1) differences in conceptualization and operationalization, (2) differences in the unit of analysis (resident vs. facility), (3) differences in sampling method and sample constitution, and (4) differences in the main method of analysis. As an empirical test of three of these sources of variation, the authors investigated relationships between primary organizational characteristics and various measures of quality using a sample of 104 Wisconsin NFs. From both the comparative and Wisconsin analyses, implications for research are drawn.