Older adult safety while receiving home health services after hospital discharge

老年人出院后接受家庭保健服务时的安全

• 批准号: 8828082
• 负责人: Alicia Ines Arbaje
• 金额: $ 15.75万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8828082
• 关键词: Older; adult; safety; while; receiving

DESCRIPTION (provided by applicant): Errors during care transitions of older adults are common, costly, and sometimes lethal. A care transition is defined as the movement of a person from one healthcare setting to another and is commonly associated with adverse outcomes. The aging of the population is leading to greater reliance on care delivered in the home, the most common and poorly understood healthcare delivery setting. For unclear reasons, those who require skilled home healthcare (SHHC) services (e.g., home nursing) after hospital discharge are among those at highest risk of experiencing hospital readmission. Strategies tailored to the complexity of the hospital/SHHC transition are needed to ensure safe transitions, yet there is relatively little research to guide improvement efforts. The overall goal of the proposed study is to develop an index to be used by SHHC agencies in real time to identify and reduce potential risks to older adults' safety during hospital/SHHC transitions. SPECIFIC AIM 1: To identify potential risks to older adults' safety related to (1) information management among SHHC providers across settings, and (2) establishment of older adult, caregiver, and SHHC provider roles for execution of healthcare tasks. We will use prospective risk identification methods to identify potential risks: (a) direct observations of older adults' hospital/SHHC transition; and (b semi-structured interviews of older adults/caregivers/SHHC providers. SPECIFIC AIM 2: To develop an index that will be used by SHHC agencies in real time to identify risks to older adults' safety during hospital/SHHC transitions with regard to processes of information management and establishment of roles. Through focus groups, SHHC providers will rate each risk identified in SA1 on its importance to ensuring safety and its frequency of occurrence. SPECIFIC AIM 3: To evaluate psychometric properties of the index and ascertain feasibility of use. 3a. To evaluate index inter-rater reliability among SHHC providers and establish initial construct validity among care transitions that differ in quality. For inter-rater reliability, we wll determine the correlation between index scores calculated by pairs of SHHC providers evaluating a series of care transitions. For construct validity, we will compare index scores among cases that differ in care transition quality. 3b. To further evaluate construct validity usin a different standard and ascertain feasibility of use among SHHC providers. In a prospective sample of older adults receiving SHHC after hospital discharge, we will determine the correlation between SHHC provider-generated index scores and a general measure of patient-reported care transition quality (Care Transitions Measure, or CTM-3). The proposed study will fill critical gaps in the understanding of care transitions of older adults who are particularly vulnerable to safety issues. Study findings have the potential for applicability to a broader group of patients who transition from hospital to home and require complex care.

描述（由申请人提供）：老年人的护理过渡期间的错误是常见的，昂贵的，有时是致命的。护理过渡定义为一个人从一个医疗保健环境到另一种医疗保健的运动，通常与不良结果有关。人口的老龄化导致更依赖在家庭中提供的护理，这是最常见和了解的医疗保健服务环境。出于不清楚的原因，住院后需要熟练的家庭医疗保健（SHHC）服务（例如，家庭护理）的人是经历住院入院风险的最高风险的人。需要根据医院/SHHC过渡的复杂性量身定制的策略来确保安全过渡，但是很少有研究来指导改进工作。拟议的研究的总体目标是开发一个指数，以实时使用SHHC机构使用，以确定并降低医院/SHHC过渡期间老年人安全的潜在风险。具体目的1：确定与（1）跨环境中SHHC提供商之间信息管理有关的老年人安全的潜在风险，以及（2）建立老年人，照顾者和SHHC提供者在执行医疗保健任务方面的角色。我们将使用前瞻性风险识别方法来确定潜在的风险：（a）直接观察老年人医院/SHHC过渡； （B对老年人/护理人员/SHHC提供者的B半结构化访谈。具体目标2：开发SHHC机构将实时使用的指数，以确定医院/SHHC过渡期间老年人安全的风险通过焦点小组的信息管理和建立的过程，SHHC提供者将对SA1中的每个风险进行评分，以确保其对安全性和发生频率的重要性。 3A。构造有效性的过渡，我们将比较3B的护理过渡质量的索引。在出院后接受SHHC的老年人的前瞻性样本中，我们将确定SHHC提供者生成的指数评分与患者报告的护理过渡质量的一般度量（护理过渡措施或CTM-3）之间的相关性。拟议的研究将填补对特别容易受到安全问题的老年人的护理过渡的关键空白。研究结果有可能适用于更广泛的组 从医院过渡到家并需要复杂护理的患者。