Assessing and Improving Patient Safety Measurement in Nursing Homes

项目摘要 养老院收容了可能有身体和心理限制的脆弱人群，而且他们经常 缺乏倡导所需的财政、政治和社会手段。确保养老院里的人的安全 要获得高质量的护理，公众对这些设施的监督至关重要。当前努力的核心部分 为了监控和改善疗养院的患者安全，依赖于最低数据集3.0(MDS)，该数据集 包含疗养院自我报告的患者级别的健康评估。医疗保险中心 基于这些评估的医疗补助服务质量指标和五星评级表明，已经取得了进展 是在过去十年中取得的。然而，鉴于MDS与其他数据来源之间的不一致， 以及表明MDS报告可能不可靠的调查和审计，有理由质疑 数据的完整性，从而是目前监测疗养院患者安全的联邦方法。我们 建议使用疗养院患者的医疗保险和医疗补助索赔来确定导致 去医院看病。我们的重点将放在MDS的四个患者安全部分，即跌倒、压疮、 尿路感染(尿路感染)和肺炎，所有这些通常都可以预防，但没有适当的护理 会导致严重的生理和心理疾病和死亡。这将允许评估 提高对MDS的报道质量，这是我们的首要目标。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需要去医院就诊，所有病例都会导致 MDS应适当记录就诊情况。我们还将评估MDS报告中的变化 患者和疗养院特征的准确性，特别注重按种族识别差异 和医疗补助计划的注册。在我们的第二个目标中，我们将评估重大事件后MDS报告行为的变化 受伤跌倒包括在五星级评级计算中。在第三个目标中，我们将利用索赔来开发 疗养院患者安全的替代措施，即更严重的 这些临床情况。我们将评估这些基于索赔的利率与其他措施之间的联系 病人安全的问题。除了研究这些发病率及其趋势外，我们还将评估发病率的变化。 按疗养院特征划分的比率，特别注重按种族组合和 比例医疗补助。最后，我们将描述疗养院目前的排名在 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 将是评估当前方案的有效性和改善未来努力的关键一步 公众。我们将特别关注种族和医疗补助支付者在MDS报告率中的地位以及我们的 基于索赔的患者安全措施，以确定差异，因为少数族裔和穷人可能在 接受低质量护理的风险。我们希望为政策制定者提供具体的、基于证据的见解 用于在这些环境中显著改进患者安全工具。

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.