Improvement in Patients' Cognition and Relationship with SNF Quality Measures

通过 SNF 质量措施改善患者的认知和关系

• 批准号: 10321594
• 负责人: Brian Gregory Downer
• 金额: $ 12.25万
• 依托单位: UNIVERSITY OF TEXAS MED BR GALVESTON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-01-01 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10321594
• 关键词: Address; Admission activity; Alzheimer' s disease related dementia; Area; Care given by nurses; Career Mobility; Caring; Characteristics; Clinical; Cognition; Cognitive; Communities; Data; Data Files; Decision Making; Dementia; Development; Elderly; Epidemiology; Funding; Gerontology; Goals; Health; Health Policy; Health care facility; Hospitals; Impaired cognition; Incentives; Intervention; Knowledge; Lead; Measures; Medical; Medical Care Team; Medicare; Mentors; Methodology; Nursing Homes; Outcome; Patients; Performance; Persons; Physical Function; Policies; Polypharmacy; Process Assessment; Public Health; Recovery; Rehabilitation therapy; Reporting; Research; Research Activity; Research Personnel; Research Project Grants; Research Training; Risk; Risk Adjustment; Risk Factors; Site; Skilled Nursing Facilities; Study Skills; Texas; Training; Training Activity; Universities; Variant; acute care; base; care outcomes; career development; experience; follow-up; functional status; improved; large datasets; leadership development; modifiable risk; professor; programs; rehabilitation science; skills

PROJECT SUMMARY/ABSTRACT I am an assistant professor in the Division of Rehabilitation Sciences at the University of Texas Medical Branch in Galveston, Texas. The purpose of this K01 proposal is to provide me with the knowledge, analytical skill, and experience necessary to become a successful investigator. To me, this means I will develop a funded research program that advances the quality of post-acute care for older adults, in particular for those with cognitive impairment, Alzheimer's disease and related dementias. My K01 application is focused on skilled nursing facilities (SNFs) because they are the most frequent post-acute care site for older adults. My training in gerontology has focused on analyzing cognitive data and using large data sets to identify potentially modifiable risk factors for cognitive impairment and dementia. During the K01 period, I will receive training in four areas that build upon my prior training in gerontology and expertise on the epidemiology of dementia: (1) Health characteristics, assessment process, quality outcomes and follow-up needs associated with older adults receiving SNF care; (2) Operational standards and regulatory (decision making) policies of SNFs; (3) Statistical skills for studying post-acute care outcomes using claims data; and (4) Career advancement and leadership development. Training in these areas will include coursework, shadowing interdisciplinary teams in clinical settings, and experiences accessing, managing, and analyzing Medicare files. This training will make me a researcher with a highly-informed view of healthcare policy and clinical context. My training activities have been integrated with a research project in which I will use national Medicare data files (2012-2014) to complete the following specific aims: (A) Evaluate the change in cognitive status during a SNF stay for older adults with impaired cognition on admission; (B) Examine the variation across SNFs in the percentage of patients with impaired cognition on admission whose cognitive status improves during a SNF stay; and (C) Assess the relationship between cognitive status on admission, improvement in cognitive status during a SNF stay, and performance on SNF quality measures. The expected findings of this research can inform clinical interventions that target patient- and facility-level characteristics associated with improved cognitive status. The findings can also inform healthcare policies meant to incentivize nursing homes to provide high-quality post-acute care. Completion of the K01 mentored training and research plans will provide me with the knowledge and skills necessary to develop a program of research that will advance the quality of post-acute care for older adults, in particular for older adults with cognitive impairment, Alzheimer's disease and related dementias.

项目摘要/摘要 我是德克萨斯大学医学分校康复科学系的助理教授 在德克萨斯州的加尔维斯顿。这份K01提案的目的是为我提供知识、分析技能、 以及成为一名成功的调查员所必需的经验。对我来说，这意味着我将开发一种 研究计划，提高老年人急性后护理的质量，特别是那些患有 认知障碍、阿尔茨海默病和相关痴呆症。我的K01申请的重点是熟练的 护理设施(SNF)，因为它们是老年人最常见的急性后护理网站。我受过的培训 老年学专注于分析认知数据，并使用大型数据集来识别潜在的可修改 认知障碍和痴呆症的危险因素。在K01期间，我将接受四个方面的培训 这是建立在我之前的老年学培训和痴呆症流行病学专业知识的基础上的：(1)健康 与老年人相关的特征、评估过程、质量结果和后续需求 接受SNF护理；(2)SNF的操作标准和监管(决策)政策；(3)统计 使用索赔数据研究急症后护理结果的技能；以及(4)职业发展和领导力 发展。这些领域的培训将包括课程作业，跟踪临床跨学科团队 设置以及访问、管理和分析Medicare文件的体验。这次训练将使我成为一名 对医疗保健政策和临床背景有高度了解的研究人员。我的训练活动 我与一个研究项目整合在一起，在该项目中，我将使用国家医疗保险数据文件(2012-2014)完成 以下具体目标：(A)评估老年人在SNF住院期间认知状态的变化 入院时认知受损；(B)检查SNF之间的差异 入院时认知状况改善的入院认知受损；及(C)评估 入院时的认知状态、住院期间认知状态的改善与 对SNF质量措施的绩效。这项研究的预期结果可以为临床干预提供依据。 这一目标是与改善认知状态相关的患者和设施水平的特征。这些发现可以 还告知医疗保健政策，旨在激励疗养院提供高质量的急性后护理。 完成K01指导培训和研究计划将为我提供知识和技能 有必要制定一项研究计划，以提高老年人急性后护理的质量， 尤其是有认知障碍、阿尔茨海默病和相关痴呆症的老年人。