Outcomes of Nursing Management Practice in Nursing Homes

疗养院护理管理实践的成果

基本信息

批准号：
8313857
负责人：
RUTH A ANDERSON
金额：
$ 69.22万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
1994
资助国家：
美国
起止时间：
1994-09-01 至 2016-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8313857
关键词：
Accounting Address Behavior Behavior monitoring Behavioral Blinded Blood Pressure Caring Case Study Climate Clinical Cognitive Communication Complex Decision Making Decubitus ulcer Dementia Discipline of Nursing Elderly Empirical Research Ensure Environment Evidence based practice Fall prevention Fostering Foundations Frail Elderly Frail Older Adults Gait Gold Health Health Services Research Healthcare House Staffs Impaired cognition Impairment Incontinence Intervention Intervention Studies Knowledge Learning Measures Mediating Medical Mentorship Modeling Modification Nursing Homes Orthostasis Outcome Outcome Assessment Outcome Measure Pain Patients Pattern Perception Pharmaceutical Preparations Physical therapy Population Practice Guidelines Practice Management Prevention program Problem Solving Process Progress Reports Quality of Care Randomized Recurrence Research Risk Factors Risk Reduction Safety Science Self-Help Devices Sensory Social Problems Syndrome System Techniques Testing Translating Translational Research Vitamin D Work adverse outcome arm base behavior change coping density design efficacy trial evidence base fall risk falls functional decline improved insight member multi-component intervention primary outcome programs prospective secondary outcome self organization standard of care trend

项目摘要

DESCRIPTION (provided by applicant): Although efficacy trials have identified interventions that reduce adverse outcomes such as falls in nursing home (NH) residents, attempts to translate those interventions into practice using current standard of care quality improvement (QI) techniques have not been successful. Using a complexity science framework, our previous RO1 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. Our pilot test of "CONNECT", a multi-component intervention that encourages staff use simple strategies to make new connections with others, enhance information flow, and use cognitive diversity, demonstrated that staff can learn to improve the density and quality of their interactions, and that this change in behavior is associated with a trend to lower fall rates. We hypothesize that higher levels of connection, information flow and cognitive diversity fostered in the CONNECT Intervention 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 and a standard falls QI program (CONNECT + FALLS) or FALLS alone. We estimate that 800 residents and 576 staff members will participate. Specific aims are to, in nursing homes: 1) Compare the impact of the CONNECT intervention plus a falls reduction QI intervention (CONNECT+FALLS) to a falls reduction QI intervention (FALLS) on fall risk reduction indicators (orthostatic blood pressure, sensory impairment, footwear appropriateness, gait; assistive device; toileting needs, environment, and psychotropic medication); 2) Compare the impact of CONNECT+FALLS to FALLS alone on fall rates and injurious falls, and determine whether these are mediated by the change in fall risk reduction indicators; 3) Compare the impact of CONNECT+FALLS to FALLS alone on complexity science measures (communication, participation in decision making, local interactions, safety climate, staff perceptions of quality) and determine whether these mediate the impact on fall risk reduction indicators and fall rates and injurious falls. Cross-sectional observations of complexity science measures are taken at baseline, at 3 months, at 6 months, and at 9 months. Resident fall risk reduction indicators, fall rates, and injurious falls are measured for the 6 months prior to the first intervention and the 6 months after the final intervention is completed. Fall risk reduction indicators are the primary outcome. Secondary outcome measures include fall rates, injurious falls, and complexity science measures (communication, participation in decision making, local interactions, safety climate, staff perceptions of quality). Analysis will use a 3-level mixed model to account for the complex nesting of patients and staff within nursing homes, and to control for covariates associated with fall risk, including baseline facility fall rates and staff turnover rates.

描述（由申请人提供）：尽管功效试验已经确定了减少不良结果（例如疗养院居民（NH）居民跌倒）的干预措施，但试图使用当前的护理质量改进（QI）技术将这些干预措施转化为实践，但尚未成功。使用复杂的科学框架，我们以前的RO1表明，NH员工之间的连接，信息流和认知多样性较低，这解释了为复杂问题（例如跌倒）提供的许多较差的护理质量。我们对“ Connect”的试点测试是一种多组分的干预措施，鼓励员工使用简单的策略与他人建立新的联系，增强信息流并使用认知多样性，这表明员工可以学会提高其相互作用的密度和质量，并且这种行为变化与降低跌倒率的趋势相关。我们假设在连接干预中培养的更高的连接，信息流量和认知多样性是必要的，然后才能成功进行复杂的老年病问题（例如跌倒）的任何QI干预。这项为期5年的研究将使用前瞻性，群集的结果评估盲目的设计，而NHS（n = 16）随机分配给连接和标准跌倒QI计划（Connect + Falls）或单独落下。我们估计将有800名居民和576名员工参加。具体目的是在疗养院中：1）比较连接干预的影响以及减少质量干预（Connect+Falls）与减少跌落QI干预（跌落）对跌倒风险降低指标（正常血压，感觉障碍，感觉障碍，鞋类障碍，鞋类适应性，助理设备；辅助设备； 2）将Connect+跌倒的影响与跌倒率和有害跌倒的影响进行比较，并确定这些影响是否是由降低风险降低指标的变化所介导的； 3）将Connect+跌倒的影响仅落在复杂性科学措施（沟通，参与决策，当地互动，安全环境，员工对质量的看法）上，并确定这些影响是否介导了对降低风险降低的指标和跌倒率以及跌倒率以及跌倒的影响。复杂性科学措施的横断面观察在基线，3个月，6个月和9个月时进行。居民降低风险指标，跌倒率和有害跌倒的次数是在第一次干预之前的6个月和最终干预完成后的6个月的衡量。降低风险降低指标是主要结果。次要结果措施包括跌倒率，有害的跌倒和复杂性科学指标（沟通，参与决策，地方互动，安全气候，员工对质量的看法）。分析将使用3级混合模型来说明疗养院内患者和员工的复杂筑巢，并控制与跌倒风险相关的协变量，包括基线设施跌倒率和员工周转率。