PhD in Nursing Science Program
Cathy A. Maxwell
Administratively-Mediated Variables and Outcomes of Hospitalized Injured Older Adults
Dissertation under the direction of Professor Lorraine C. Mion
This dissertation study examined hospital structures and processes associated with outcomes among hospitalized injured older adults (HIOA). The Minnick and Roberts Outcomes Production Model guided the design of a study that examined: 1) presence of geriatric-specific quality indicators in acute care hospitals that provide care to HIOAs; 2) associations among mutable organizational factors and adoption of quality indicators; and 3) the extent to which mutable organization factors, including geriatric-specific quality indicators explained variations in one adverse event (deep vein thrombosis [DVT] or pulmonary embolus [PE]) in HIOAs. Findings indicate that adoption of geriatric-specific quality indicators remains low. Factors associated with adoption of quality indicators included computerized support for clinical decision-making and comprehensive geriatric assessment. In a final regression model that represented four levels of hypothesized influence, after controlling for the influence of all other variables, the strongest adjusted associations with rates of DVT or PE were for comorbidities, and hospitals with simulated home and community rehabilitation environments. Despite ten years of efforts to promote adoption of geriatric-specific quality indicators, much progress remains to be made. The occurrence of DVT/PE in HIOAs remains a problem and should be carefully considered as a quality indicator.