Assessing and Improving Patient Safety Measurement in Nursing Homes

项目摘要 疗养院收容的弱势群体可能有身体和心理上的限制， 缺乏宣传所需的财政、政治和社会手段。为了确保养老院里的人安全 并接受高质量的护理，公众对这些设施的监督至关重要。当前努力的核心部分 为了监测和改善疗养院的病人安全，依靠最小数据集3.0（MDS）， 包含由疗养院自我报告的患者级健康评估。医疗保险中心 医疗补助服务质量指标和基于这些评估的五星评级表明， 在过去的十年里。然而，鉴于MDS与其他数据来源之间的不一致， 以及调查和审计表明MDS报告可能不可靠，因此有理由质疑 数据的完整性，从而目前的联邦方法来监测疗养院病人的安全。我们 建议使用养老院患者的医疗保险和医疗补助索赔来确定导致 医院探访我们将重点关注MDS的四个患者安全部分，即福尔斯、压疮、 尿路感染（UTI）和肺炎，所有这些疾病通常都是可以预防的，但没有适当的护理 可导致严重的生理和心理疾病和死亡。这将有助于评估 我们的首要目标是提高MDS报告的质量。这里的指导原则是，虽然只有一部分， 发生在疗养院的病例将严重到足以保证医院就诊，所有导致 MDS应适当记录医院访视。我们还将评估MDS报告的变化 患者和疗养院特征的准确性，特别关注按种族识别差异 和医疗补助登记在我们的第二个目标中，我们将估计重大医疗事故后MDS报告行为的变化。 受伤的福尔斯也包括在五星评级计算中。在第三个目标中，我们将使用索赔来开发 护理院患者安全的替代措施，即更严重病例的发生率， 这些临床条件。我们将评估这些基于索赔的比率与其他措施之间的关联 患者安全。除了研究这些比率及其趋势外，我们还将评估发病率的变化 按疗养院特点分列的比率，特别侧重于按种族混合确定差异， 比例医疗补助。最后，我们将描述如何目前排名的养老院可能会改变下， 基于索赔的措施。这项工作将推进养老院护理系统的安全和质量研究。它 这将是评估当前项目有效性和改善未来工作的关键一步， 公众我们将特别关注MDS报告率中的种族和医疗补助支付者身份， 以索赔为基础的病人安全措施，以确定差距，因为少数民族和穷人可能特别是在 接受低质量护理的风险。我们希望提供具体的、基于证据的见解， 用于显著改善这些环境中的患者安全工具。

Project Summary Nursing homes house vulnerable people who may have physical and psychological limitations and also often lack the financial, political, and social means required for advocacy. To ensure people in nursing homes are safe and receiving high quality of care, public monitoring of these facilities is crucial. A core part of current efforts to monitor and improve patient safety in nursing homes rely on the Minimum Data Set 3.0 (MDS), which contains patient-level health assessments that are self-reported by nursing homes. The Centers for Medicare and Medicaid Services quality measures and five-star ratings based on these assessments suggest progress has been made over the past decade. However, in light of inconsistencies between the MDS and other data sources, and investigations and audits that suggest MDS reporting may be unreliable, it is reasonable to question the integrity of the data and thereby the current federal approach to monitoring nursing home patient safety. We propose to use Medicare and Medicaid claims of nursing home patients to identify health events that led to hospital visits. Our focus will be on four patient safety sections of the MDS, namely falls, pressure ulcers, urinary tract infections (UTIs), and pneumonia, all of which are generally preventable but without proper care can lead to serious physical and psychological morbidity and mortality. This will allow assessment of the quality of reporting on the MDS, our first aim. The guiding principle here is that while only a portion of the cases that occur in nursing homes would be serious enough to warrant a hospital visit, all cases that result in a hospital visit should be appropriately recorded by the MDS. We will also assess variations in MDS reporting accuracy by patient and nursing home characteristics, with a particular focus on identifying disparities by race and Medicaid enrollment. In our second aim, we will estimate changes in MDS reporting behavior after major injury falls were included in the five-star ratings calculations. In the third aim, we will use the claims to develop alternative measures of patient safety in nursing homes, that is the incidence rates of the more severe cases of these clinical conditions. We will assess the associations between these claim-based rates and other measures of patient safety. In addition to studying these rates and their trends, we will assess variations in incidence rates by nursing home characteristics, with a particular focus on identifying disparities by race mix and proportion Medicaid. Finally, we will describe how current rankings of nursing homes may shift under the claims-based measures. This work will advance safety and quality research for the nursing home care system. It will be a crucial step towards evaluating the effectiveness of current programs and improving future efforts by the public. We will pay specific attention to race and Medicaid payer status in MDS reporting rates and our claims-based patient safety measures to identify disparities, as minorities and the poor may be especially at risk of receiving low-quality care. We expect to provide specific, evidence-based insights that policymakers can use to substantially improve patient safety tools in these settings.