The Geriatric Institutional Assessment Profile (GIAP)
The Geriatric Institutional Assessment Profile (GIAP) is an instrument that helps NICHE-participating hospitals assess their institutional readiness to provide quality care to older adults prior to implementing NICHE. (1)
The GIAP is meant to be used as a proxy measure for the overall quality of care provided to elderly patients and thus serve as a benchmarking tool to assist hospitals in identifying gaps in knowledge about geriatric care, attitudes and perceptions that influence how staff work with older patients, specific practice issues and concerns, and organization attributes of the hospital relevant to geriatric care.
The GIAP is a 152-item self-report survey instrument that includes two main sub-scales, the Geriatric Care Environment Scale and the Geriatric Care Knowledge Scale (formerly referred to as the Best Care Environment and the Best Care Knowledge scales). (1) The factorial structure of the 28-item Geriatric Care Environment Scale (GCES) of the GIAP was tested in a sample of 9,400 staff RNs at 71 acute hospitals, who responded to the GIAP from 1999 to 2004, split randomly into two groups for the purpose of cross-validation. The GCES is internally consistent (Chronbach alpha =.93) and accounts for about 55% of the total variance. The four factors extracted from the exploratory factor analysis are Aging-Sensitive Care Delivery, Resource Availability, Institutional Values Regarding Older Adults and Staff, and Capacity for Collaboration. The four-factor structured model is validated in a half-randomly selected sample (NFI=.931 NNFI=.933, CFA=.939, RMSEA=.058), and do not vary significantly across the four groups of RNs who worked at the four different types of hospitals (NFI=.969, NNFI=.975, CFA=.976, RMSEA=.027). (2)
The more than 30,000 staff-completed responses from more than 100 hospitals represent hospitals in 35 states (and 3 Canadian provinces) and includes community, regional, rehabilitation, and academic medical centers. This database thus provides an ideal basis for benchmarking a NICHE hospital against similar hospitals in key measures of staff knowledge/attitudes and institutional support.(3)
Additionally, the GIAP can assist administrators and researchers to document improvement in the nurse’s perception of care provided to older hospitalized adults. The GIAP survey is administrated by the NICHE coordinator at each hospital. All survey data is then sent to the NYU Hartford Institute NICHE Benchmarking Service and maintained by the NICHE Program Evaluator. Data is received by the NICHE Benchmarking Service without any identifying information of the individual staff person who completes the survey.
References
(1) Abraham I, Bottrell M. M., Dash, K. et al. (1999) Profiling care and benchmarking best practice in care of hospitalized elderly: the Geriatric Institutional Assessment Profile. Nursing Clinics of North America, 34(1), 237-255.
(2) Kim, H., Capezuti, E., Boltz, M., Fairchild, S., Fulmer, T., & Mezey, M. (2007). Factor structure of the geriatric care environment scale. Nursing Research, 56 (5), 339-347.
(3) Fulmer, T., Mezey, M., Bottrell, M., Abraham, I., Sazant, J., Grossman, S. et al (2002). Nurses Improving Care for Healthsystem Elders (NICHE): using outcomes and benchmarks for evidenced-based practice. Geriatric Nursing, 23(3), 121-127.
NYU Hartford Institute NICHE Benchmarking Service
The NYU Hartford Institute NICHE Benchmarking Service analyzes the GIAP data and produces a report for the individual hospital. The GIAP data highlights hospital strengths and weaknesses regarding care of the elderly. It provides your hospital with:
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Benchmarking of your staff against other hospitals
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Baseline with which to judge the effectiveness of CQI (continuing quality improvement) efforts
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Objective evidence of deficiencies in knowledge levels
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Evidence of improvement necessary for JCAHO accreditation
The Geriatric Institutional Assessment Profile (GIAP) Database
The GIAP Database contains data completed by health care staff of NICHE participating facilities. This is not a patient database and thus does not include any patient data. It does not contain any protected health information (PHI) or individually identifiable health information as defined by the Privacy Act. Specifically, direct identifiers of the individual or of relatives, employers, or household members of the health care staff completing the GIAP are not collected and thus are not in the dataset. The database contains one identifying variable: a hospital identification number. This number is issued by the NICHE Program Evaluator. A list of hospital identification numbers and the names of the hospitals is contained in a separate electronic file that is separate from the database. References The Privacy Rule, also known as the Standards for Privacy of Individually Identifiable Health Information, are the regulations issued by the Department of Health and Human Services in relation to the Health Insurance Portability and Accountability Act of 1996 (HIPAA).This became a requirement on April 14, 2003. See:
http://privacyruleandresearch.nih.gov/pdf/research_repositories_final.pdf
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The on-line GIAP is user-friendly; it takes approximately 15 minutes to complete.
This sample hospital surveyed only nursing staff. Other hospitals seek the input of multiple disciplines.
Staff perception of the appropriateness of treatments helps identify priority areas for quality initiatives.
Gaps between attitudes and knowledge are important considerations when planning staff development programs.
