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) 的特点是碎片化且成本高昂的“系统”快速增长，并且对质量存在严重而持久的担忧。健康相关的生活质量 (HRQoL) 已被领先的临床学者确定为美国日益增长的接受 LTC 的老年人口质量评估的焦点结果。不幸的是，缺乏关于反映多个领域变化轨迹的数据。该人群的 HRQoL。因此，老年人及其家人没有足够的信息来评估各种长期护理方案的质量，临床医生和政策制定者也没有知识基础来确保高质量、具有成本效益的服务。拟议的纵向研究旨在解决这些重要的知识差距，具有三个主要目标：（1）检查 HRQoL 多个领域（即生物和生理因素、症状状态、功能状态、两年内新接受三种长期护理方案之一的老年人的情绪状态、行为状态、一般健康认知和感知的整体生活质量； (2) 通过检查留在各自长期护理方案至少一年的老年人的匹配样本中的这些模式，比较各个长期护理方案中每个领域的变化模式； (3) 评估多个 HRQoL 领域和显着背景因素之间的因果关系，包括反映设施结构和护理流程的因素，以便为未来研究中测试此类关系提供经验基础。平均分布在长期护理中心、疗养院 (NH)、辅助生活设施 (ALF) 以及家庭和社区服务 (H&CBS) 的主要提供者中，共有 468 名新入住长期护理中心的同意老人将接受 9 次访谈（基线加上每个访谈）基线后 3 个月到两年）使用一套全面的有效且可靠的工具，统称为 HRQoL 评估。与 HRQoL 领域以及可能影响它们的护理结构和流程相关的数据将通过员工访谈、病历摘要和设施调查生成。对于目标 1，将使用“模式混合”方法查找缺失数据，对 LTC 选项内的两年患者轨迹进行自然检查，以考虑随着时间的推移而发生的损耗。目标 2 分析将重点比较长期护理选项之间从入院到第 6 个月和第 12 个月的 HRQoL 领域变化分布情况，这些老年人在各自的长期护理环境中停留至少一年，使用倾向模型来调整选择偏差。目标 3 分析将包括应用因果分析来评估 HRQoL 领域在整个因果链中的中介和调节作用，这些作用由基本概念框架隐含。其他探索性目标将指导分析护理结构和过程对 HRQoL 领域变化的影响。本研究将考察两年内新接受三种长期护理方案之一的老年人 HRQoL 多个领域中每个领域变化的自然史。这项研究的结果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并做出与长期护理相关的明智选择。