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Patient Safety Culture in Assisted Living: Association with Outcomes

辅助生活中的患者安全文化：与结果的关联

基本信息

批准号：
10380621
负责人：
HELENA TEMKIN-GREENER
金额：
$ 34.26万
依托单位：
UNIVERSITY OF ROCHESTER
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-07-01 至 2024-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10380621
关键词：
Patient Safety Culture Assisted Living

项目摘要

Project Summary/Abstract Assisted living (AL) communities in the U.S. were largely designed to fill the gap between independent living and nursing home by providing housing and support services. The acuity of persons living in AL has increased over the last two decades, and today more than 50% of AL residents require supportive care such as help with medications and assistance in activities of daily living (ADLs), 40% have moderate to severe dementia, and 90% some degree of cognitive impairment. The rapid growth of AL communities has occurred largely without federal financing or oversight and with variable state regulatory efforts and stringency. Consequently, relatively little is known about the safety culture of the AL environment and its impact on residents' safety and health outcomes. The 1999 Institute of Medicine (IOM) report “To Err is Human” prompted many healthcare organizations to focus on “patient safety culture” and the need to organize their care processes so as to minimize care delivery errors and improve the provision of patient care. In the last decade, significant progress to improve safety culture (e.g. teamwork, management support for patient safety) in acute care hospitals, and to some extent in nursing homes, has been made and the literature shows that improved safety culture is associated with better patient outcomes. By comparison AL communities, which are state-regulated, receive no or little scrutiny from federal policy makers, the state oversight of these organizations vary widely, and even less is known about their safety culture. AL communities have substantially fewer reporting requirements than nursing homes yet to a large extent serve residents with similar care needs. It is not known if and to what extent the stringency of state AL regulations impacts the development of safety culture practices in this care setting, and how both of these forces influence residents' outcomes. To address these significant gaps in knowledge our proposed project will examine the variation in AL patient safety culture, its relationship to residents' health outcomes, and the potential impact of state regulations on safety culture and outcomes. We propose to survey administrators and direct care workers in a large, nationally representative sample of ALs using an adapted version of the AHRQ patient safety survey instrument. We will employ existing databases of state ALR regulations and policies. We will use Medicare administrative and claims data to identify AL residents and to define risk-adjusted outcomes. We will also employ public use data to define other needed covariates. These data will be used to construct AL patient safety culture measures, measures of state stringency, measures of residents' risk-adjusted outcomes, and facility, market and state covariates. Hypotheses will be tested using multivariable regressions. The information generated through this study will increase knowledge of AL communities and their ability to adequately and safely serve their residents. The project will provide the much-needed evidence for the design of future practice and policy initiatives aimed at improving patient safety and care quality in AL.

项目总结/摘要美国的辅助生活（AL）社区主要旨在填补独立生活之间的差距和养老院提供住房和支持服务。生活在AL的人的敏锐度有所提高在过去的二十年里，今天超过50%的AL居民需要支持性护理，如帮助药物和日常生活活动（ADL）的援助，40%有中度至重度痴呆，90% 一定程度的认知障碍AL社区的快速增长主要是在没有联邦政府的情况下发生的。融资或监督，以及可变的国家监管努力和严格性。因此，了解AL环境的安全文化及其对居民安全和健康结果的影响。 1999年医学研究所（IOM）的报告《人皆有错》促使许多医疗机构，注重“病人安全文化”和组织护理流程的必要性，以尽量减少护理服务错误和改善病人护理的提供。在过去十年中，在改善安全文化方面取得了重大进展 (e.g.团队合作，病人安全的管理支持）在急性护理医院，并在一定程度上在护理家庭，已经取得了文献表明，改善安全文化与更好的病人结果。相比之下，由州政府管理的AL社区没有或很少受到联邦的审查政策制定者认为，国家对这些组织的监督差异很大，对其安全性的了解更少文化在很大程度上，AL社区的报告要求比养老院少得多为有类似护理需求的居民提供服务。目前尚不清楚州AL法规的严格性是否以及在多大程度上影响安全文化实践在这一护理环境的发展，以及这两种力量如何影响居民的成果。为了解决这些重大的知识差距，我们拟议的项目将审查 AL患者安全文化的变化，其与居民健康结果的关系，以及国家的潜在影响关于安全文化和结果的规定。我们建议调查管理人员和直接护理人员在一个大的，全国代表性的样本，使用AHRQ患者安全性调查工具的改编版本的AL。我们将利用现有的数据库，国家ALR法规和政策。我们将使用医疗保险管理和索赔数据来识别AL居民并定义风险调整后的结果。我们还将使用公共使用数据来定义其他所需的协变量。这些数据将用于构建AL患者安全文化措施、州严格措施、措施居民的风险调整后的结果，设施，市场和国家的协变量。假设将使用多变量回归通过这项研究产生的信息将增加对AL社区的了解以及他们为居民提供充分和安全服务的能力。该项目将提供急需的证据设计未来的实践和政策举措，旨在改善AL患者的安全和护理质量。

项目成果

期刊论文数量（15）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Patient Safety Culture in Assisted Living: Staff Perceptions and Association with State Regulations.

辅助生活中的患者安全文化：工作人员的看法以及与国家法规的关联。

DOI：
10.1016/j.jamda.2022.09.007
发表时间：
2022
期刊：
Journal of the American Medical Directors Association
影响因子：
7.6
作者：
Temkin-Greener,Helena;Mao,Yunjiao;McGarry,Brian;Zimmerman,Sheryl
通讯作者：
Zimmerman,Sheryl

Utilization and Functional Outcomes Among Medicare Home Health Recipients Varied Across Living Situations.

医疗保险家庭健康受益者的利用率和功能结果因生活情况而异。

DOI：
10.1111/jgs.16949
发表时间：
2021
期刊：
Journal of the American Geriatrics Society
影响因子：
6.3
作者：
Wang,Jinjiao;Ying,Meiling;Temkin-Greener,Helena;Shang,Jingjing;Caprio,ThomasV;Li,Yue
通讯作者：
Li,Yue

Home time and state regulations among Medicare beneficiaries in assisted living communities.

辅助生活社区中医疗保险受益人的家庭时间和州法规。

DOI：
10.1111/jgs.18709
发表时间：
2024
期刊：
Journal of the American Geriatrics Society
影响因子：
6.3
作者：
Mao,Yunjiao;Li,Yue;McGarry,Brian;Wang,Jinjiao;Temkin-Greener,Helena
通讯作者：
Temkin-Greener,Helena

End-Of-Life Care In Assisted Living Communities: Race And Ethnicity, Dual Enrollment Status, And State Regulations.

辅助生活社区的临终关怀：种族和民族、双重注册身份和州法规。

DOI：
10.1377/hlthaff.2021.01677
发表时间：
2022
期刊：
Health affairs (Project Hope)
影响因子：
0
作者：
Temkin-Greener,Helena;Guo,Wenhan;Hua,Yechu;Li,Yue;Caprio,Thomas;Schwartz,Lindsay;Cai,Shubing
通讯作者：
Cai,Shubing

Hospital Proximity and Emergency Department Use among Assisted Living Residents.

辅助生活居民的医院距离和急诊室使用情况。