TESTING A GAPN CARE MODEL FOR ELDERS WITH HIP FRACTURE

描述：(改编自申请者的摘要) 医疗保健的时间、顺序和协调的经验性模型 给65岁以上的髋部骨折的人的是 求婚。拟议的测试的理由是：死亡率不变 在过去20年中经历髋部骨折的老年人的比率； 相对较新的刻意强调全面质量管理 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有效性；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--老年髋关节疾病护理) 骨折)提供了研究框架；它基于通用的 卫生服务研究和前期的结构/过程/结果模型 研究结果确立了髋部骨折的康复轨迹。 干预措施包括使用科学派生的长期护理 改善老年患者康复效果的管理方案 在护理环境中体验髋部骨折(ECP)，以及使用 由老年高级实践护士(GAPN)提供的ECP，该护士将担任 一个研究小组的病例经理。ECP规定了客户的结果 由于骨折后四个阶段的干预而发生 康复：急性、亚急性、活动和健康。GAPN将使用 ECP可指导和协调不同护理环境中多名护理人员的护理 六个多月。这项研究将在HealthEast和 更广泛的综合服务提供系统；其中包括急性护理 设施、康复设施、过渡护理设施、护理 家庭和家庭护理机构。采用随机两组设计。 符合抽样标准的140名客户(允许进入以下一项 修复髋部骨折的三个HealthEast急救机构 在家中发生、符合联邦医疗保险条件、年龄和65岁、在以下年龄段之前在门诊就诊 骨折)将随机平均分配到以下两组中的一组 试验组，将根据ECP接受护理，即 由新闻出版总署管理和协调，以及一个控制小组，该小组将只 根据ECP接受护理。对干预效果的分析应用 重复测量的方差分析和t检验将包括：1)组内 研究对象在实现特定恢复结果方面的比较 (健康状况、功能独立、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)；以及2)照顾者之间在以下方面的比较 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).