The Volume-Outcome Relationship in Nursing Home Care An Examination of Functional Decline Among Long-term Care Residents
The Volume-Outcome Relationship in Nursing Home Care An Examination of Functional Decline Among Long-term Care Residents
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DOI：
10.1097/mlr.0b013e3181bd4603
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发表时间：
2010-01-01
期刊：
影响因子：
3
通讯作者：
Glance, Laurent G.
中科院分区：
文献类型：
--
作者：
Li, Yue;Cai, Xueya;Glance, Laurent G.
背景：广泛的证据表明，患者数量和医院护理中改善的临床结果之间存在关系。本研究旨在确定长期护理居民的养老院数量与身体功能减退率之间是否存在类似的关联。方法：我们对9336家养老院的605,433名符合条件的长期住院患者的2004年和2005年的最低数据集文件进行了回顾分析。这一结果是根据联邦“养老院比较”措施确定的，该措施收集了连续两个季度之间日常生活状况的4项基本活动的变化。结果测量和养老院容量都是基于长期护理居民的基础上定义的。我们估计随机效应Logistic回归模型来量化容量对功能衰退的独立影响。结果：随着容量的增加，养老院功能衰退的未调整率趋于较低。在对基线居民特征和设施内居民的嵌套进行多因素调整后，与低容量养老院(30-51人/设施)相比，高容量养老院(101人/设施)的居民日常生活能力下降的优势比为0.82(95%可信区间：0.79-0.86，P<；0.000)。结论：养老院长期护理人员数量高与功能下降总体较轻。需要进一步的研究来测试其他重要的养老院结果，并探索各种机构、人员和资源属性，这些属性是长期护理的体积-结果关联的基础。了解更多的大容量设施的经验如何导致更好的住院结果可能有助于指导疗养院的质量改进努力。
Background: Extensive evidence has demonstrated a relationship between patient volume and improved clinical outcomes in hospital care. This study sought to determine whether a similar association exists between nursing home volume of long-term care residents and rates of decline in physical function.Methods: We conducted retrospective analyses on the 2004 and 2005 Minimum Data Set files that contain 605,433 eligible long-term residents in 9336 nursing homes. The outcome was defined following the federal "Nursing Home Compare" measure that captures changes in 4 basic activities of daily living status between 2 consecutive quarters. Both the outcome measure and nursing home volume were defined on the basis of long-term care residents. We estimated random-effects logistic regression models to quantify the independent impact of volume on functional decline.Results: As volume increased, nursing home's unadjusted rate of functional decline tended to be lower. After multivariate adjustment for baseline resident characteristics and the nesting of residents within facilities, the odds ratio of activities of daily living decline was 0.82 (95% confidence interval: 0.79-0.86, P < 0.000) for residents in high-volume nursing homes (>101 residents/facility), compared with residents in low-volume facilities (30-51 residents/facility).Conclusions: High volume of long-term care residents in a nursing home is associated with overall less functional decline. Further studies are needed to test other important nursing home outcomes, and explore various institutional, staffing, and resource attributes that underlie this volume-outcome association for long-term care. Understanding how greater experience of high-volume facilities leads to better resident Outcome may help guide quality improvement efforts in nursing homes.