Health related quality of life: Elders in long-term care

与健康相关的生活质量：长期护理中的老年人

• 批准号: 7145572
• 负责人: MARY D NAYLOR
• 金额: $ 48.46万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-01 至 2011-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7145572
• 关键词: behavioral /social science research tag; clinical research; community health services; emergency care; emotional adjustment; extended care; functional ability; home for elderly; home health care; hospital utilization; human mortality; human subject; interview; longitudinal human study; nursing homes; psychological aspect of aging; quality of life; residential care facility; social support network

DESCRIPTION (provided by applicant): Currently long term care (LTC) is characterized by the rapid growth of a fragmented and costly "system" with substantial and persistent concerns about quality. Health related quality of life (HRQoL) has been identified by leading clinical scholars as a focal outcome for quality assessment among the growing population of elders receiving LTC in the U.S. Unfortunately there is a paucity of data regarding the trajectory of changes in the multiple domains reflecting HRQoL in this population. As a result, elders and their families have inadequate information upon which to assess the quality of various LTC options, and clinicians and policy makers do not have the knowledge base to assure high quality, cost-effective services. The proposed longitudinal study, designed to address these important gaps in knowledge, has three primary aims: (1) to examine the natural history of changes in each of the multiple domains of HRQoL (i.e. biological and physiological factors, symptom status, functional status, emotional status, behavioral status, general health perceptions and perceived overall quality of life) among elders newly admitted to one of three LTC options over a two year period; (2) to compare patterns of change in each of these domains across LTC options by examining these patterns among a matched sample of elders who remain in their respective LTC option for at least one year; and, (3) to evaluate causal relationships among multiple HRQoL domains and salient contextual factors including those reflecting facility structure and care process in order to provide an empirical basis for testing such relationships in future studies. Equally distributed throughout major providers of LTC, nursing homes (NHs), assisted living facilities (ALFs), and home and community-based services (H&CBS), a total of 468 consenting elders newly admitted to LTC will receive 9 interviews (baseline plus every 3 months through two years post-baseline) using a comprehensive set of valid and reliable instruments collectively called the HRQoL Assessment. Data related to the HRQoL domains and the structure and processes of care that may influence them will be generated through staff interviews, medical record abstractions, and facility surveys. For Aim 1, a naturalistic examination of two-year patient trajectories within LTC option will be conducted accounting for attrition over time using the 'pattern mixture' approach for missing data. Aim 2 analyses will focus on comparisons among LTC options in the distributions of changes in HRQoL domains from admission to months 6 and 12 among elders remaining in their respective LTC settings for at least one year using propensity modeling to adjust for selection bias. Aim 3 analyses will include applying causal analyses to evaluate the mediating and moderating effects of HRQoL domains across the causal chain that are implied by the underlying conceptual framework. Additional exploratory aims will guide analyses of the effects of structure and process of care on changes in HRQoL domains. This study will examine the natural history of changes in each of the multiple domains of HRQoL among elders newly admitted to one of three long term care options over a two year period. The findings from this study will enable policy makers and providers, as well as recipients of long term care services, to evaluate and make informed choices related to long-term care.

描述（由申请人提供）：目前长期护理（LTC）的特征是零散且昂贵的“系统”的快速增长，对质量有实质性和持续的关注。不幸的是，在美国，在美国越来越多的长老人群中，与健康相关的生活质量（HRQOL）已确定为质量评估的焦点，不幸的是，关于反映该人群HRQOL的多个领域变化的轨迹的数据很少。结果，长者及其家人不足以评估各种LTC期权的质量，临床医生和政策制定者没有知识库来确保高质量，具有成本效益的服务。拟议的纵向研究旨在解决知识中的这些重要差距，具有三个主要目的：（1）检查HRQOL多个领域的自然历史（即生物学和生理因素，症状状态，功能状态，情感状态，情感状态，行为状态，行为状态，健康感知以及一般的健康质量）在Eldered pers persed pers pers pers pers pers pers pers pers pers pers pers pers pers pers的质量; （2）通过在匹配的长者样本中检查这些模式，这些模式在其各自的LTC选项中至少一年； （3）评估多个HRQOL领域和显着上下文因素之间的因果关系，包括反映设施结构和护理过程的因素，以便为在未来的研究中测试这种关系提供经验基础。在LTC，疗养院（NHS），辅助生活设施（ALFS）以及家庭和社区服务（H＆CBS）中平均分发，共有468个同意的老年人将使用有效的仪器进行全面的仪器，将获得9次访谈（每3年至BASELINT），将获得9次访谈（每3个月至基线）（基线再加上两年）。与HRQOL域以及可能影响它们的护理结构和过程有关的数据将通过员工访谈，病历摘要和设施调查产生。对于AIM 1，将对LTC选项中的两年患者轨迹进行自然主义检查，以使用“模式混合”方法来考虑随着时间的流逝，以丢失数据。 AIM 2分析将重点介绍LTC选项之间的比较，以使用倾向建模来调整选择偏见的倾向建模，从而至少一年，从入院到第6和12个月的HRQOL域的变化分布。 AIM 3分析将包括应用因果分析来评估HRQOL域在整个因果链中的介导和调节作用，这些影响是基本的概念框架所暗示的。其他探索目的将指导对结构和护理过程对HRQOL域变化的影响的分析。这项研究将研究HRQOL多个领域的变化的自然历史，在两年内，新近接受三个长期护理选择之一的长者中的一种。这项研究的发现将使政策制定者和提供者以及长期护理服务的接受者能够评估和做出与长期护理有关的明智选择。