Multilevel Intervention to Improve Nursing Home Outcomes

多层次干预改善疗养院的结果

基本信息

批准号：
7572957
负责人：
MARILYN J RANTZ
金额：
$ 52.8万
依托单位：
UNIVERSITY OF MISSOURI-COLUMBIA
依托单位国家：
美国
项目类别：
财政年份：
2005
资助国家：
美国
起止时间：
2005-05-01 至 2011-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7572957
关键词：
Activities of Daily Living Address Administrator Adopted Adoption Age Aging American Attention Bladder Body Weight decreased Bundling Care given by nurses Caring Categories Classification Clinical Management Commit Communication Complex Congresses Control Groups Cost Control Data Set Decision Making Decubitus ulcer Development Direct Costs Discipline of Nursing Effectiveness Effectiveness of Interventions Elderly Elements Employee Environment Facility Controls Family member Fecal Incontinence Fostering Funding Glean Goals Group Meetings Group Processes Health Hearing Home environment Human Resources Institution Intervention Intervention Studies Leadership Learning Life Literature Long-Term Care Measures Methods NIH Program Announcements Nurses Nursing Homes Organizational Change Organizational Culture Outcome Outcome Measure Physical assessment Prevalence Process Quality Indicator Quality of Care Quality of life Randomized Reporting Research Research Personnel Side System Testing Translating Work base care delivery care systems cost cost effective design experience functional status improved nursing intervention programs tool

项目摘要

DESCRIPTION (provided by applicant): This proposed intervention study addresses the Program Announcement, Long-Term Care Quality of Life and Quality of Care. In this study, we seek to improve the outcomes of residents by transforming poorly performing nursing home staffs into good ones - a task of pressing national importance. We propose to accomplish this by bundling the best clinical and management approaches gleaned from our preliminary work and from a formerly fragmented set of studies by others, including organizations as complex adaptive systems. Our intervention will be comprehensive, and it will be the first to work at multiple levels: We will work side-by-side with the firmly guide direct-care direct care staff at poorly performing nursing homes to facilitate their adoption of excellent care systems and practices. We will also foster a professional and inclusive nursing management style and an organizational culture that embraces on-going improvement and systematically carries quality-improvement practices forward. Based on our recently completed NINR-funded study, "Nursing Care Processes, Outcomes and Cost in Nursing Homes" (1998-2003, Rantz, PI), we have designed a randomized, two-group, repeated-measures design to test a two-year experimental intervention for improving quality of care and subsequently improving resident outcomes in nursing homes. Facilities with resident outcomes in need of improvement will receive an experimental multilevel intervention that helps staff (1) use quality-improvement methods, (2) use team and group process for direct-care decision-making, (3) focus on accomplishing the basics of care and (4) maintain more consistent nursing and administrative leadership committed to communication and active participation of staff in decision-making. The multilevel intervention will involve all levels of nursing home staff; that is, owners, administrators and direct-care staff at 64 facilities in three states. We will use both qualitative and quantitative methods to measure the effectiveness of the intervention. An attention control group will receive information about aging and physical assessment of elders. We will measure resident outcomes with selected quality indicators from nursing home Minimum Data Set: bladder and bowel incontinence, weight loss, pressure ulcers and decline in activities of daily living (ADL). We will measure staff retention; direct-care costs, total costs, and detailed costs; staffing and staff mix, and employees' views of selected organizational attributes before, during and after the intervention. Similarly, we will observe processes of care delivery before, during and after the multilevel intervention to describe the adoption of the care delivery strategies recommended in the intervention.

描述（由申请人提供）：这项拟议的干预研究涉及计划公告，长期护理质量和护理质量。在这项研究中，我们试图通过将表现不佳的疗养院工作人员转变为良好的居民来改善居民的成果 - 这是迫切需要国家重要性的任务。我们建议通过捆绑从我们的初步工作中收集的最佳临床和管理方法以及以前的其他人（包括组织为复杂的自适应系统）中零散的研究来实现这一目标。我们的干预将是全面的，这将是第一个在多个层面上工作的人：我们将与稳固的指导直接指导直接护理人员并肩工作，表现不佳，以促进他们采用出色的护理系统和实践。我们还将培养一种专业和包容的护理管理风格，并培养一种组织文化，该文化具有持续的进步，并系统地采用了质量改进实践。基于我们最近完成的忍者资助研究“护理过程，疗养院的结果和成本”（1998-2003，Rantz，PI），我们设计了一种随机的，两组重复的重复设计设计，以测试两年的实验性干预措施，以改善护理质量，并随后改善居民在培训中的居民。需要改进的居民结果的设施将获得实验性的多层次干预措施（1）使用质量改进方法，（2）使用团队和小组流程进行直接保健决策，（3）专注于完成护理的基础，（4）（4）保持更一致的护理和行政领导，并致力于与员工进行决策。多层次干预将涉及所有级别的疗养院工作人员；也就是说，在三个州的64个设施的所有者，管理人员和直接护理人员。我们将使用定性和定量方法来衡量干预的有效性。注意控制小组将收到有关老年人老龄化和身体评估的信息。我们将通过疗养院最少数据集的选定质量指标来衡量居民结果：膀胱和肠失尿，减肥，压力溃疡和日常生活活动（ADL）的下降。我们将衡量人员保留；直接护理成本，总成本和详细成本；人员和员工组合，以及在干预期间，之后和之后，员工对选定的组织属性的看法。同样，我们将在多层次干预之前，之中和之后观察护理交付过程，以描述干预中建议的护理交付策略。

项目成果

期刊论文数量（5）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

The influence of teams to sustain quality improvement in nursing homes that "need improvement".

团队对维持“需要改进”的疗养院质量改进的影响。

DOI：
10.1016/j.jamda.2012.09.008
发表时间：
2013
期刊：
Journal of the American Medical Directors Association
影响因子：
7.6
作者：
Rantz,MarilynJ;Zwygart-Stauffacher,Mary;Flesner,Marcia;Hicks,Lanis;Mehr,David;Russell,Teresa;Minner,Donna
通讯作者：
Minner,Donna

Pain management in nursing homes: what do quality measure scores tell us?

疗养院的疼痛管理：质量衡量分数告诉我们什么？