TESTING A GAPN CARE MODEL FOR ELDERS WITH HIP FRACTURE

描述：（改编自申请人的摘要） 医疗保健的时间、顺序和协调的计算机衍生模型 为65岁以上髋部骨折的人提供的治疗是 提议 建议的测试是合理的：不变的死亡率 在过去20年中，发生髋部骨折的老年人的发病率; 相对较新的全面质量管理， 需要仔细解释护理过程;缺乏研究 在不同环境中测试护理管理方案的功效;以及 医疗保健提供系统效率低下，被认为会导致 成本和护理质量下降。 项目的概念框架 以结果为中心的护理管理模式（OutTCM） 骨折）提供了研究框架;它是基于一个通用的 卫生服务研究的结构/过程/结果模型 研究发现建立了髋部骨折的康复轨迹。 干预措施包括使用科学衍生的扩展护理 改善老年人康复结果的管理方案 在整个护理环境中经历髋部骨折（ECP），以及使用 由一名老年学高级实践护士（GAPN）提供ECP， 一个研究小组的案例经理。 ECP规定了客户端结果， 由于骨折后四个阶段的干预， 恢复：急性、亚急性、活动性和健康。 GAPN将使用 ECP指导和协调多个护理人员在护理环境中的护理 超过六个月 该研究将在HealthEast内进行， 提供综合服务的怀尔德系统，包括急症护理 设施，康复设施，过渡护理设施，护理 家庭和家庭护理机构。 提出了一种随机两组设计。 140名符合抽样标准的客户（进入其中一个 三家HealthEast急性护理机构用于髋关节骨折修复 发生在家中，符合Medicare资格，年龄> 65岁， 骨折）将随机平均分配到两组中的一组： 实验组将根据ECP接受护理， 由GAPN管理和协调，以及一个控制组， 根据ECP进行护理。 干预效果分析 重复测量ANOVA和t检验将包括：1）组间 研究受试者实现特定恢复结局的比较 （健康状况、功能独立性、居家生活和满意度） 在每个阶段结束时和骨折后12个月（假设1和 研究问题1）;和2）照顾者之间的比较， 他们实施ECP以影响结果（假设2和研究 问题2）。

DESCRIPTION: (Adapted from the Applicant's Abstract) The test of an empirically-derived model to time, sequence, and coordinations of healthcare given to persons over the age of 65 who fracture a hip is the focus of the proposal. The proposed test is justified by: the unchanging mortality rates over the past 20 years among elderly who experience hip fractures; the relatively new deliberate emphasis on Total Quality Management which requires careful explication of the processes of care; the lack of research testing of the efficacy of care management protocols across settings; and healthcare delivery system inefficiencies thought to result in increased cost and decreased quality of care. The conceptual framework of the project (Outcomes-Focused Care Management [OuTCM] Model for Care of Elderly with Hip Fractures) provides the study framework; it is based on a generic structure/process/outcome model for health services research and prior research findings establishing the trajectory of recovery from hip fracture. The interventions include use of a scientifically-derived extended care management protocol for improving recovery outcomes in elderly clients experiencing hip fracture across care settings (the ECP), and the use of the ECP by a Gerontological Advanced Practice Nurse (GAPN) who will serve as a case manager for one study group. The ECP specifies client outcomes that occur as a result of the intervention in four phases of post-fracture recovery: acute, subacute, mobility, and wellness. The GAPN will use the ECP to guide and coordinate care by multiple caregivers across care settings over six months. The study will be carried out within the HealthEast and Wilder systems of integrated service delivery; they include acute care facilities, a rehabilitation facility, a transitional care facility, nursing homes and home care agencies. A randomized two-group design is proposed. One hundred forty clients meeting the sampling criteria (admission to one of three HealthEast acute care facilities for repair of a hip fracture occurring at home, Medicare eligible, age > 65, ambulatory prior to fracture) will be randomly and equally assigned to one of two groups: an experimental group which will receive care according to the ECP which is managed and coordinated by the GAPN, and a control group which will only receive care according to the ECP. Analysis of intervention effects using repeated measures ANOVA and t-tests will include: 1) between-group comparisons of study subjects on achievement of specified recovery outcomes (health status, functional independence, living at home, and satisfaction) at the end of each phase and at 12 months post fracture (hypothesis 1 and research question 1); and 2) comparisons between caregivers on the extent to which they implemented the ECP to effect outcomes (hypothesis 2 and research question 2).