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.

由于虐待、忽视和剥削，政策制定者和研究人员长期以来一直对疗养院居民的福祉表示担忧。由于阿尔茨海默病患者的年龄以及身体和认知能力的下降，疗养院居民特别容易受到虐待和忽视。痴呆症（AD）和阿尔茨海默病相关痴呆症（ADRD）的功能状态较差，认知障碍更严重，并且日常活动严重依赖护理人员，他们更有可能面临超过20%的护理虐待。房屋被引用为国家背景调查计划 (NBCP) 是一项州级自愿计划，旨在减少长期护理机构（包括疗养院）中对弱势居民的虐待、忽视和剥削。根据参与 NBCP 的计划要求，各州必须检查 a) 未来雇员居住的所有州的虐待登记处，b) 州犯罪历史记录，c) 基于指纹的 FBI 记录，以及 d) 该州的任何其他记录可能包含联邦立法允许的不合格信息。每个州获得最多 300 万美元的赠款来实施 NBCP 自 2010 年以来，有 29 个州和地区在不同年份获得了实施 NBCP 的资金，并且处于不同的实施阶段。尚不清楚。有一些证据表明，背景调查可能会在潜在的施虐者被雇用之前将其抓获，而且，背景调查也可能会阻止潜在的施虐者申请养老院的工作。但是，背景调查可能无法抓获所有的虐待罪犯。 NBCP 的实施可能我们的目标是总体上评估 NBCP 在减少居民虐待、忽视和剥削以及改善疗养院患者安全结果方面的有效性，并通过 AD/ADRD 普查来实现这一目标。针对三个具体目标的计量经济学分析： 1) 评估 NBCP 对犯有虐待、忽视和剥削行为的员工的就业的影响，2) 评估 NBCP 对滥用、忽视和剥削行为的总体和影响按高分层与低 AD/ADRD 人口普查相比，以及 3) 评估 NBCP 对不良患者质量结局的影响：整体以及 AD/ADRD 个体的营养不良、脱水、抑郁、跌倒、压疮、感染和抗精神病药物的使用研究结果将产生关于 NBCP 在减少住院患者虐待、忽视和剥削以及改善疗养院患者安全结果方面的有效性的重要新知识，我们的结果有可能影响 CMS 政策。关于各州使用 NBCP 来改善 AD/ADRD 人群的结果。