Outcomes of Nursing Management Practice in Nursing Homes

疗养院护理管理实践的成果

• 批准号: 8069493
• 负责人: RUTH A ANDERSON
• 金额: $ 2.64万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-05-13 至 2011-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8069493
• 关键词: Accounting; Behavior; Behavior monitoring; Behavioral; Blinded; Caring; Case Study; Clinical; Clinical Trials; Cognitive; Collaborations; Communication; Complex; Decision Making; Decubitus ulcer; Discipline of Nursing; Educational process of instructing; Effectiveness; Elderly; Empirical Research; Failure; Fostering; Foundations; Frail Elderly; Frail Older Adults; Future; Health; Health Services Research; Healthcare; Home Nursing Care; Home environment; Incontinence; Individual; Intervention; Intervention Studies; Knowledge; Leadership; Learning; Long-Term Care Nursing; Measurement; Measures; Mediating; Medical; Mental Depression; Mentors; Modeling; Modification; Nursing Homes; Occupations; Outcome; Outcome Assessment; Outcome Measure; Outcome Study; Pain; Patients; Pattern; Population; Practice Management; Problem Solving; Process Measure; Provider; Publications; Quality of Care; Randomized; Recurrence; Reporting; Research; Risk Factors; Safety; Science; Social Problems; Syndrome; Techniques; Testing; Translating; Translational Research; Translations; Work; adverse outcome; arm; base; density; design; evidence base; fall risk; falls; improved; innovation; member; novel strategies; point of care; post intervention; programs; prospective; prototype; psychologic; routine practice; skills; theories

Project Summary Although several clinical trials have identified interventions that reduce adverse outcomes such as falls in nursing home (NH) residents, attempts to translate those interventions into practice using widely accepted quality improvement (QI) techniques have not been successful. Our previous R01, using a complexity science framework, has shown that low connection, information flow, and cognitive diversity among NH staff explains much of the poor quality of care delivered for complex problems such as falls. Additional pilot work showed that our "CONNECT" intervention fosters staff in learning to improve the density and quality of their interactions. CONNECT is a multi-component intervention based on our previous case study research that encourages staff to engage in network-building and use simple strategies to enhance information flow, connection among staff, and cognitive diversity. We hypothesize that high levels of connection, information flow and cognitive diversity are necessary before any QI intervention for a complex geriatric problem, such as falls, can be successful. This 5-year study will use a prospective, cluster-randomized, outcome assessment blinded design, with NHs (n=16) randomized to either CONNECT+FALLS or FALLS alone. We estimate that 560 residents and 576 staff members will participate. Specific aims are (1) Aim 1 (primary) Compare the impact of the CONNECT intervention plus a falls reduction QI intervention (CONNECT+FALLS) to the falls reduction QI intervention alone (FALLS), on fall-related outcome measures in NH residents; (2) Aim 2 (exploratory): Compare the impact of CONNECT+FALLS to FALLS alone on fall-related process measures in NH residents, and determine whether these mediate the impact on fall-related outcome measures. (3) Aim 3 (exploratory): Compare the impact of CONNECT+FALLS to FALLS alone on staff interaction measures, as reported by NH staff, and determine whether these mediate the impact on fall-related process measures and fall-related outcome measures. Measurements of staff interaction and residents' fall-related outcomes are taken at baseline, post intervention, 3 and 6 months. Fall rates and proportion of recurrent fallers is the primary study outcome. Exploratory measures include fall-related process measures and staff interaction measures (communication; participation, group-to-group interaction, psychological safety, and safety culture). Analysis will use a 3-level mixed model to account for the complex nesting of patients and staff within homes, and control for covariates associated with fall risk, including baseline facility fall rates. In order to promote the health of the frail NH population, it is essential to identify interventions to improve the translation of research advances into actual practice. The CONNECT intervention integrates behavioral/complexity science with principles of health services research, and has the potential to improve care in NHs for many complex medical and psycho-social problems among frail older adults.

项目摘要 尽管几项临床试验已经确定了减少不良后果的干预措施，例如落入 疗养院（NH）居民试图使用广泛接受的 质量改进（QI）技术尚未成功。我们以前的R01，使用复杂性 科学框架表明，NH员工之间的连接，信息流和认知多样性较低 解释了用于复杂问题（例如瀑布）提供的许多较差的护理质量。其他飞行员工作 表明我们的“连接”干预促进了员工的学习来提高其密度和质量 互动。 Connect是基于我们先前的案例研究的多组分干预措施 鼓励员工参与网络建设并使用简单策略来增强信息流， 员工之间的联系以及认知多样性。我们假设高水平的连接，信息 在对复杂的老年问题进行任何QI干预之前，需要进行流量和认知多样性，例如 作为瀑布，可以成功。 这项为期5年的研究将使用前瞻性，聚集的，结果评估盲目的设计，并具有 NHS（n = 16）随机将连接+跌落或单独跌落。我们估计有560名居民和 576名工作人员将参加。具体目的是（1）目标1（主要）比较 连接干预加上减少量Qi干预（Connect+Falls）的跌落量降低量 仅干预（跌落），对NH居民的秋季相关结果指标； （2）AIM 2（探索性）： 比较连接+跌倒的影响单独跌至NH中与跌倒相关的过程度量 居民，并确定这些是否介导了对跌倒相关结果指标的影响。 （3）目标3 （探索性）：比较连接+的影响属于员工互动措施，例如 由NH工作人员报告，并确定这些是否介导了对跌倒相关过程措施的影响 和与跌倒有关的结果指标。员工互动和居民与跌倒有关的结果的测量 在干预后3个月和6个月时进行。跌倒率和复发堕落者的比例是 主要研究结果。探索性措施包括与跌倒相关的过程措施和员工互动 措施（沟通；参与，小组互动，心理安全和安全性 文化）。分析将使用3级混合模型来说明患者和员工的复杂筑巢 在房屋内，并控制与跌倒风险相关的协变量，包括基线设施跌倒率。 为了促进脆弱的NH人口的健康，必须确定改善干预措施 研究转化为实际实践。连接干预整合 行为/复杂性科学与卫生服务研究原则，并有可能改善 在NHS中护理脆弱的老年人中许多复杂的医学和心理社会问题。