Improving the Quality of Care in Nursing Homes

提高疗养院的护理质量

• 批准号: 7098169
• 负责人: JOHN N. MORRIS
• 金额: $ 56.99万
• 依托单位: HEBREW REHABILITATION CENTER FOR AGED
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-04-05 至 2010-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7098169
• 关键词: behavioral /social science research tag; clinical research; extended care; health care personnel performance; health care quality; health care service evaluation; health services research tag; human subject; nursing care quality; nursing homes; nursing research; nursing skill /technique; outcomes research; patient oriented research; quality of life; training

DESCRIPTION (provided by applicant): This revised proposal is submitted in response to PA-02-162 "Long-Term Care Recipients: Quality of Life and Quality of Care Research" co-sponsored by the National Institute on Aging. With this proposal, the Hebrew Rehabilitation Center for Aged, in collaboration with the Massachusetts Department of Public Health, implement and evaluate the efficacy of an intervention to increase the number of high quality nursing homes in Massachusetts. The study involves mounting a 3 arm intervention in randomly selected nursing homes identified as performing in the aggregate at a poor or at best average level across multiple outcome domains. We call our program "SAVE" - standing for Sustaining Achievable Vitality and Effectiveness. The SAVE program brings together 2 approaches to care, 1 utilizing an organizational continuous quality improvement (CQI) system that includes problem recognition, evidence-based care, and evaluation; and the second the implementation of specific care protocols targeted at specific outcome areas. The 3 arms of our intervention include a control group delivering usual care, and 2 active treatment arms, 1 implementing the CQI programming (SAVE-CQI), the second implementing the CQI program and the specific protocol programming (SAVE-CQI+). We will sample from Massachusetts nursing homes and accrue to the study 40 that demonstrate adequate data quality but in, at least some of 12 clinical care areas, but have sub-optimal outcomes in these areas. 24 will be assigned randomly to 1 of the active treatment arms, and 16 to the usual care control condition. We will use MDS data for facility residents of record over a 15-month period to measure changes in presumed quality of care using 12 of the Centers for Medicare and Medicaid Services quality indicators. PUBLIC HEALTH IMPORTANCE: This is an ambitious project, however, the importance of the research is amplified in this era of shrinking public resources and demographic changes resulting increasing numbers of frail, older adults requiring residential long-term care. The intervention itself is relatively low cost, as it will be designed for implementation by a facility's existing staff, and could be implemented in a larger number of facilities using extant resources if the evaluation is favorable.

描述（由申请人提供）：该修订的提案是针对PA-02-162的“长期护理接受者：生活质量和护理研究的质量”提交的，由国家衰老研究所共同赞助。通过这项建议，希伯来语康复中心与马萨诸塞州公共卫生部合作，实施和评估干预措施增加马萨诸塞州高质量养老院的效力。这项研究涉及在随机选择的疗养院中安装3臂干预措施，这些疗养院在多个结果域中以较差或平均水平为差的疗养院。我们称我们的计划为“保存” - 代表维持可实现的活力和有效性。保存计划汇集了两种护理方法，1利用组织持续质量改进（CQI）系统，其中包括问题识别，基于证据的护理和评估；第二个针对特定结果领域的特定护理方案的实施。我们干预的3个臂包括一个提供常规护理的对照组，以及2个主动治疗组，1个实施CQI编程（Save-CQI），第二个实施CQI程序和特定协议编程（Save-CQI+）。我们将从马萨诸塞州的疗养院采样，并累积研究40，以证明数据质量足够，但至少有12个临床护理区中的一些，但在这些领域的结果是优越的。 24将被随机分配给1个主动治疗组中的1个，而16则分配给通常的护理控制条件。我们将使用Medicare和Medicaid服务质量指标的12个中心使用MDS数据进行15个月内的设施居民，以衡量假定护理质量的变化。公共卫生的重要性：这是一个雄心勃勃的项目，但是，在这个缩小公共资源和人口变化的时代，该研究的重要性被放大，导致越来越多的脆弱的老年人需要住宅长期护理。干预本身的成本相对较低，因为它将设计用于设施现有员工的实施，如果评估有利，则可以使用现有资源在大量设施中实施。