Improving Quality of Care for Persons with Dementia in Nursing Homes – Evaluation of the National Background Check Program

提高疗养院痴呆症患者的护理质量 — 对国家背景调查计划的评估

• 批准号: 10662838
• 负责人: Hari Sharma
• 金额: $ 13.39万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10662838
• 关键词: Affect; Affordable Care Act; Age; Alzheimer' s Disease; Alzheimer' s disease related dementia; Antipsychotic Agents; Caregivers; Censuses; Cessation of life; Communication; Coupled; Data; Dehydration; Dementia; Effectiveness; Elder Abuse; Elderly; Employee; Employment; Evaluation; Face; Failure; Fingerprint; Fracture; Funding; Goals; Grant; Healthcare; Heterogeneity; Impaired cognition; Incidence; Individual; Infection; Injury; Investments; Knowledge; Life; Link; Long-Term Care; Malnutrition; Mental Depression; Nursing Homes; Occupations; Outcome; Pain; Patients; Personal Satisfaction; Persons; Physical Function; Policies; Policy Maker; Population; Predisposition; Public Health; Quality of Care; Quality of life; Quasi-experiment; Recording of previous events; Records; Registries; Reporting; Research Personnel; Resource Allocation; Resources; Savings; Services; Statutes and Laws; Stress; Surveys; Variant; Voluntary Programs; Vulnerable Populations; abuse neglect; adverse outcome; care providers; cognitive function; convict; cost; decubitus ulcer; design; econometrics; effectiveness evaluation; elder neglect; experience; falls; financial exploitation; functional status; human old age (65+); improved; improved outcome; maltreatment; mortality; neglect; patient safety; perpetrators; physical abuse; programs; prospective; psychologic; safety outcomes; sexual assault; treatment effect

Policymakers and researchers have long expressed concerns about resident wellbeing in nursing homes because of abuse, neglect, and exploitation. Nursing home residents are particularly susceptible to abuse and neglect because of their age, as well as physical and cognitive decline. Since individuals with Alzheimer ’s disease (AD) and Alzheimer’s Disease Related-Dementias (ADRD) have poorer functional status, more severe cognitive impairment, and are heavily dependent on caregivers for their daily activities, they are more likely to face abuse and mistreatment. Over 20% of nursing homes are cited for abuse, neglect, and exploitation every year. The National Background Check Program (NBCP) is a state-level voluntary program aimed at reducing abuse, neglect, and exploitation of vulnerable residents in long-term care settings including nursing homes. As part of the program requirements for participation in NBCP, states are required to check a) abuse registries of all states in which the prospective employee lived, b) state criminal history records, c) fingerprint-based FBI records, and d) any other records in the state that may have disqualifying information. Federal legislation allows each state to obtain up to $3 million in grants to implement NBCP. Since 2010, 29 states and territories have obtained the funding to implement NBCP over different years and are in various stages of implementation. However, link between background checks and abuse/resident outcomes is not clear. There is some evidence to show that background checks may catch potential abusers before they are hired. Moreover, background checks may also deter potential abusers from applying for jobs in nursing homes. However, background checks may not catch all perpetrators of abuse and implementation of NBCP may also lead to workforce shortages. Our objective is to evaluate the effectiveness of NBCP in lowering resident abuse, neglect, and exploitation and improving patient safety outcomes in nursing homes, overall, and by AD/ADRD census. To achieve this goal, we propose an econometric analysis for three specific aims: 1) To estimate the effect of NBCP on employment of staff who are guilty of abuse, neglect, and exploitation, 2) To estimate the effect of NBCP on citations for abuse, neglect, and exploitation, overall and stratified by high vs. low AD/ADRD census, and 3) To estimate the effect of NBCP on adverse patient quality outcomes: malnutrition, dehydration, depression, falls, pressure sores, infections, and utilization on antipsychotic drugs, overall and for individuals with AD/ADRD. The study results will yield important new knowledge about the effectiveness of NBCP in lowering resident abuse, neglect, and exploitation and improving patient safety outcomes in nursing homes, overall, and for persons with AD/ADRD. Our results have the potential to affect CMS policies on states’ use of NBCP to improve outcomes for AD/ADRD population.

政策制定者和研究人员长期以来一直对护士居民的居民因虐待，忽视和剥削而表示关注。养老院居民特别容易因其年龄以及身体和认知能力下降而遭受虐待和忽视。由于患有阿尔茨海默氏病（AD）和阿尔茨海默氏病有关的患者（ADRD）的功能状况较差，更严重的认知障碍，并且很大程度上依赖于护理人员的日常活动，因此他们更有可能面临虐待和虐待。每年，超过20％的护士房屋被滥用，忽视和剥削。国家背景调查计划（NBCP）是一项州级自愿计划，旨在减少在包括护士住宅在内的长期护理环境中对弱势居民的虐待，忽视和剥削。作为参与NBCP的计划要求的一部分，各州必须检查a）滥用前瞻性雇员所居住的州的滥用登记处，b）国家犯罪历史记录，c）基于指纹的联邦调查局记录和d）该州的任何其他记录可能取消资格的信息。联邦立法允许每个州获得多达300万美元的赠款来实施NBCP。自2010年以来，有29个州和地区获得了在不同年份实施NBCP的资金，并且处于实施的各个阶段。但是，背景调查与滥用/居民成果之间的链接尚不清楚。有证据表明，背景调查可能会在被录用之前捕获潜在的虐待者。此外，背景调查还可以确定潜在的虐待者在护士家庭中申请工作。但是，背景调查可能不会抓住所有滥用和实施NBCP的肇事者，也可能导致劳动力短缺。我们的目标是评估NBCP在降低居民滥用，忽视和剥削方面的有效性，并通过AD/ADRD人口普查来改善疗养院的患者安全结果。为了实现这一目标，我们为三个具体目的提出了经济分析：1）估计NBCP对虐待，忽视和剥削有罪的员工的影响，2）估算NBCP对滥用，忽视和剥削的滥用的影响，并通过高位/ADRD Census和3）对NBCP的影响，并估算出对高位和3级的影响：整体和AD/ADRD患者的营养不良，脱水，抑郁，跌倒，压疮，感染和利用。这项研究结果将产生有关NBCP在降低居民滥用，忽视和剥削方面的有效性的重要新知识，并改善了护士家庭，总体以及AD/ADRD患者的患者安全结果。我们的结果有可能影响CMS政策对国家使用NBCP来改善AD/ADRD人群的预后。