Comparative effectiveness of home care environments for diverse elders' outcomes

家庭护理环境对不同老年人结果的比较有效性

• 批准号: 8598636
• 负责人: Olga F. Jarrín Montaner
• 金额: $ 14.88万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-01 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8598636
• 关键词: Comparative; effectiveness; home; care; environments

Project Summary The candidate is a community/public health nurse and gerontological health services researcher committed to comparative effectiveness research on home health delivery systems. Her short-term training objectives are (1) to develop comparative effectiveness research methods expertise and (2) data management and analytic methods specific to home health care datasets and research design issues. Long term research goals are to improve the design and deliver of home health nursing care outcomes for a rapidly aging and increasingly diverse population. In addition to focused research, career development plans include interaction with colleagues on her mentoring/research team, formal course work will be taken in comparative effectiveness research methods. The University of Pennsylvania will provide an outstanding environment for her career development. Resources include access to eminent interdisciplinary faculty who collaborate through focused Research Centers in Health Services Research, Aging and Comparative Effectiveness Research, across the Schools of Nursing, Medicine, Sociology, Statistics, and Business. Guided by excellent mentors, in a superb training environment, with access to rich datasets and strong preliminary data, this proposal addresses three specific aims: 1) Compare the effectiveness of nursing delivery system strategies (more nurses educated at the baccalaureate level, "front-loading" of nursing visits, and supportive agency work environments) to improve home health patient outcomes~ 2) Determine if and under what conditions the impact of nursing on home health outcomes is contingent upon informal caregiver assistance~ and 3) Determine the extent of racial/ethnic disparities in home health outcomes, and determine which nursing system delivery strategies are most likely to be associated with improved outcomes for racial/ethnic minority patients and clinically complex older adults. The proposed training and research will utilize the latest advances in comparative effectiveness research methods to detect racial/ethnic disparities in home health outcomes, understand the contributing factors (individual, family, community and health systems), and evaluate the comparative effectiveness of nursing delivery system strategies on improving outcomes for home health patients under different individual and socio-environmental circumstances. This innovative project will capitalize on a unique data set, comprised of nurse surveys providing detailed information about nursing care and work environment within home health agencies in nearly 250 home health agencies that serve older adults living in diverse communities. The nurse survey results combined with independent home health care patient assessment and outcomes data provides a window into each patient's unique circumstances, including the complexity and severity of their health status and care needs, as well as information about their living environment and informal caregivers. Linkages with additional administrative and public datasets will provide additional key variables regarding home health agency service patterns and community measures of crime, segregation, socio-economic status and health care provider availability/shortages. The proposed research is significant because it will highlight the value of different home health nursing delivery strategies for improving patient outcomes among vulnerable populations may be achieved. The challenge being addressed--how to best provide safe, effective, and affordable home health nursing care to diverse patients--affects patient outcomes across the continuum of care from home to medical home and hospital. Limited evidence is available to guide home health care systems administrators in making decisions about the pros and cons of home health nursing delivery system strategies. The best combination of home health nursing care delivery strategies may be categorically different depending on the presence of informal family caregivers and community supports. Professional home health nursing care and informal (lay) or community care may interact synergistically to increase the effectiveness of systems level intervention, for example, by reducing the intensity of services needed. The comparative effectiveness study proposed will form a critical body of evidence needed to translate effective nursing delivery system strategies into evidence-based practice recommendations that providers, payers, purchasers, policy makers, other principle investigators, and the public can trust.

项目概要 候选人是社区/公共卫生护士和老年健康服务研究员 致力于家庭医疗服务系统的比较有效性研究。她的短期训练 目标是 (1) 开发比较有效性研究方法专业知识和 (2) 数据管理 以及针对家庭医疗保健数据集和研究设计问题的分析方法。长期研究 目标是改善家庭健康护理结果的设计和提供，以应对快速老龄化和 人口日益多元化。除了重点研究之外，职业发展计划还包括互动 与她的指导/研究团队的同事一起，将以比较有效的方式进行正式课程作业 研究方法。宾夕法尼亚大学将为她的职业生涯提供优越的环境 发展。资源包括接触杰出的跨学科教师，他们通过专注的合作 健康服务研究、老龄化和比较有效性研究研究中心 护理学院、医学院、社会学学院、统计学学院和商学院。在优秀导师的指导下，以精湛的 培训环境，可以访问丰富的数据集和强大的初步数据，该提案解决了三个问题 具体目标： 1) 比较护理服务系统策略的有效性（更多护士接受过以下教育） 学士学位水平、护理访问的“前期负担”以及支持性机构工作环境）以改善 家庭健康患者的结果~ 2) 确定护理是否以及在什么条件下对家庭产生影响 健康结果取决于非正式护理人员的协助~以及 3) 确定种族/民族的程度 家庭健康结果的差异，并确定哪种护理系统交付策略最有可能 与种族/族裔少数患者和临床复杂老年人的改善结果相关。 拟议的培训和研究将利用比较有效性方面的最新进展 研究方法来检测家庭健康结果中的种族/民族差异，了解其影响因素 因素（个人、家庭、社区和卫生系统），并评估比较有效性 改善不同个体家庭健康患者预后的护理服务系统策略 和社会环境情况。这个创新项目将利用一个独特的数据集，包括 护士调查提供有关家庭健康护理和工作环境的详细信息 近 250 个家庭健康机构中的机构，为生活在不同社区的老年人提供服务。护士 调查结果与独立的家庭医疗保健患者评估和结果数据相结合，提供 了解每位患者独特情况的窗口，包括其健康状况的复杂性和严重性 和护理需求，以及有关他们的生活环境和非正式护理人员的信息。与的联系 额外的管理和公共数据集将提供有关家庭健康的额外关键变量 机构服务模式和社区对犯罪、隔离、社会经济地位和健康的衡量标准 护理提供者的可用性/短缺。拟议的研究意义重大，因为它将凸显 不同的家庭健康护理提供策略可改善弱势群体的患者治疗效果 可能会实现。正在解决的挑战——如何最好地提供安全、有效和负担得起的住房 对不同患者的健康护理——影响患者从家庭到护理的整个护理过程的结果 医疗之家和医院。可用于指导家庭医疗保健系统管理员的证据有限 就家庭健康护理服务系统策略的利弊做出决策。最好的 家庭健康护理提供策略的组合可能完全不同，具体取决于 有非正式的家庭照顾者和社区支持。专业的家庭健康护理和 非正式（外行）或社区护理可以协同相互作用，以提高系统层面的有效性 例如，通过减少所需服务的强度来进行干预。比较有效性研究 提议将形成转化有效的护理服务系统策略所需的关键证据 纳入基于证据的实践建议，供提供者、付款者、购买者、政策制定者和其他人 主要调查人员，公众可以信任。