Objective: The aim of this study is to evaluate relationships between organizational, market, resident & staffing characteristics and three quality measures (QMs) in 966 free-standing California nursing facilities: weight-loss, restraints & bedfast status.

Sample: Cross-sectional data, from state and federal sources, for 2004-2005 were evaluated with ordinary least square and negative binomial regression models. The prevalence rate for: weight loss was 7.5 % (SD 3.9); 15.8% (SD 10.74) for restraints; and, 4.8% (SD 4.9) for the bedfast measure.

Results: For weight-loss our model accounted for 15% of the variation in the QM rate. Higher percentages of Hispanic individuals in the operating market and more African American and Asian residents were negatively associated with weight-loss, while more Medicare recipients and higher resident case mix were positively related to weight-loss.For restraints, our model accounted for 10% of the variation in prevalence. Number of beds and for-profit status were associated with more restraints. Prevalence rates were lower in multi-facility-chains and negatively associated with increased racial/ethnicity diversity of residents and hours of nursing care. The bedfast QM was negatively associated with the presence of family councils and positively related to Medical resident days and a more competitive operating market. Higher resident case mix and greater ADL dependency were positively related to the QM, while more Asian and Hispanic residents predicted less restraint use.

Implications: While relationships are not uniform, the QMs are related to organizational, market, resident & staffing characteristics. Associations with racial/ethnic characteristic at the market and facility levels warrants further investigation.

Benefits and Learning Objectives: To evaluate relationships between organizational, market, resident & staffing characteristics and three quality measures (QMs) in 966 free-standing California nursing facilities: Weight loss, restraints & bedfast status.