Evidence-Based Medicine in the Skilled Nursing Facility

描述(申请人提供)：科隆-埃默里克博士的目标是成为一名学术老年病学家，并在提高养老院护理质量方面成为全国公认的领导者。为了实现这一目标，她最初的工作包括完成临床研究健康科学硕士学位，以及作为布鲁克代尔国家老年医学研究员在疗养院完成关于跌倒和骨折预防的研究项目。有了保罗·A·比森奖，她计划从一名半独立的研究员发展为一名独立的研究员，因为她在定性方法论和卫生服务研究方面获得了更多的教学培训和研究经验。她的研究计划将由在这些领域拥有专业知识的导师监督，包括Kenneth Schmader博士、Morris Weinberger博士和Ruth Anderson博士。杜克大学老龄中心的丰富资源将用于支持Colon-Emeric博士的发展。她的研究计划包括两个互补的项目，有两个具体目标：1)确定加强或阻碍疗养院使用循证最佳实践的管理实践、系统特征和提供者信念；2)开发和试点测试信息技术系统干预措施，以促进疗养院基于证据的最佳实践。为了实现第一个目标，她将与调查人员合作，利用定性和定量方法，对NINR资助的高质量和低质量护理设施进行案例研究。将在2个高质量设施和2个低质量设施中与护士助理、持证护理人员、医务人员和管理人员进行半结构化访谈和焦点小组。将构建访谈探头，以阐明护理机构中骨质疏松症、跌倒和发热评估的循证护理的障碍和促进者。将使用来自较大案例研究的量化数据，包括设施质量指标、居民生活质量数据、网络分析和信息流测量。分析将描述在寻求改善循证实践的计划中应效仿或不鼓励的系统和实践。在这些结果的基础上，科隆-埃默里克博士将开发和试点测试一个信息技术系统，该系统提供评估和治疗选择、决策辅助和多学科教育工具，鼓励在现有的计算机化订单录入系统中进行基于证据的实践。常见的老年综合征疾病(尿路感染、发烧、骨质疏松症、跌倒和肺炎)将成为目标，并将使用学术和社区退伍军人管理护理家庭护理单位。

DESCRIPTION (provided by applicant): Dr. Colon-Emeric aims to become an academic geriatrician and a nationally-recognized leader in improving the quality of care in nursing homes. Her initial work toward this goal has included the completion of a Masters of Health Science in Clinical Research, and research projects on fall and fracture prevention in nursing homes as a Brookdale National Geriatrics Fellow. With this Paul A. Beeson award she plans to progress from a semi-independent to an independent investigator as she acquires additional didactic training and research experience in both qualitative methodology and health services research. Her research program will be overseen by mentors with expertise in these areas including Dr. Kenneth Schmader, Dr. Morris Weinberger, and Dr. Ruth Anderson. The rich resources of the Duke University Center for Aging will be utilized in support of Dr. Colon-Emeric's development. Her research program includes two complementary projects with two specific aims: 1) Identify management practices, system characteristics, and provider beliefs that enhance or impede the use of evidence-based best practice in nursing homes; and 2) Develop and pilot test information technology systems interventions which promote evidence-based best practice in nursing homes. To achieve the first aim she will work with investigators on a NINR-funded case-study of high and low quality nursing facilities, utilizing both qualitative and quantitative methodology. Semi-structured interviews and focus groups will be conducted with nursing assistants, licensed nursing staff, medical staff, and administrators in 2 high-quality and 2 low-quality facilities. Interview probes will be constructed to elucidate the barriers and facilitators to evidence-based care for osteoporosis, falls, and fever evaluation in nursing facilities. Quantitative data from the larger case-study including facility quality indicators, resident-level quality of life data, network analyses and measures of information flow will be used. Analyses will describe systems and practices that should be emulated or discouraged in programs seeking to improve evidence-based practice. Building on these results, Dr. Colon-Emeric will then develop and pilot test an information technology system that provides evaluation and treatment options, decision-aids, and multidisciplinary educational tools encouraging evidence-based practice within an existing computerized order entry system. Common geriatric syndromes conditions (UTI, fever, osteoporosis, falls, and pneumonia) will be targeted, and both an academic and a community-based Veterans Administration Nursing Home Care Unit will be used.