Multilevel Intervention to Improve Nursing Home Outcomes

多层次干预改善疗养院的结果

• 批准号: 6916924
• 负责人: MARILYN J RANTZ
• 金额: $ 58.84万
• 依托单位: UNIVERSITY OF MISSOURI-COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-05-01 至 2010-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6916924
• 关键词: behavioral /social science research tag; clinical research; computer data analysis; cost effectiveness; epidemiology; health care cost /financing; health care quality; health services research tag; human old age (65+); human subject; interview; nursing care evaluation; nursing care quality; nursing homes; nursing intervention; nursing process; patient oriented research; quality of life; statistics /biometry

DESCRIPTION (provided by applicant): This proposed intervention study addresses the Program Announcement, Long-Term Care Quality of Life and Quality of Care. In this study, we seek to improve the outcomes of residents by transforming poorly performing nursing home staffs into good ones - a task of pressing national importance. We propose to accomplish this by bundling the best clinical and management approaches gleaned from our preliminary work and from a formerly fragmented set of studies by others, including organizations as complex adaptive systems. Our intervention will be comprehensive, and it will be the first to work at multiple levels: We will work side-by-side with the firmly guide direct-care direct care staff at poorly performing nursing homes to facilitate their adoption of excellent care systems and practices. We will also foster a professional and inclusive nursing management style and an organizational culture that embraces on-going improvement and systematically carries quality-improvement practices forward. Based on our recently completed NINR-funded study, "Nursing Care Processes, Outcomes and Cost in Nursing Homes" (1998-2003, Rantz, PI), we have designed a randomized, two-group, repeated-measures design to test a two-year experimental intervention for improving quality of care and subsequently improving resident outcomes in nursing homes. Facilities with resident outcomes in need of improvement will receive an experimental multilevel intervention that helps staff (1) use quality-improvement methods, (2) use team and group process for direct-care decision-making, (3) focus on accomplishing the basics of care and (4) maintain more consistent nursing and administrative leadership committed to communication and active participation of staff in decision-making. The multilevel intervention will involve all levels of nursing home staff; that is, owners, administrators and direct-care staff at 64 facilities in three states. We will use both qualitative and quantitative methods to measure the effectiveness of the intervention. An attention control group will receive information about aging and physical assessment of elders. We will measure resident outcomes with selected quality indicators from nursing home Minimum Data Set: bladder and bowel incontinence, weight loss, pressure ulcers and decline in activities of daily living (ADL). We will measure staff retention; direct-care costs, total costs, and detailed costs; staffing and staff mix, and employees' views of selected organizational attributes before, during and after the intervention. Similarly, we will observe processes of care delivery before, during and after the multilevel intervention to describe the adoption of the care delivery strategies recommended in the intervention.

描述（由申请方提供）：本拟定干预研究涉及项目公告、长期护理生活质量和护理质量。在这项研究中，我们试图通过将表现不佳的养老院工作人员转变为优秀的工作人员来改善居民的结果-这是一项紧迫的国家重要性任务。我们建议通过捆绑从我们的初步工作中收集到的最佳临床和管理方法以及其他人（包括组织作为复杂适应系统）以前零散的研究来实现这一目标。我们的干预将是全面的，它将是第一个在多个层面上工作的：我们将与表现不佳的养老院的坚定指导直接护理人员并肩工作，以促进他们采用优秀的护理系统和做法。我们亦会培养专业和包容的护理管理风格，以及一种持续改善和有系统地推行品质改善措施的组织文化。基于我们最近完成的NINR资助的研究，“护理过程，护理院的结果和成本”（1998-2003年，Rantz，PI），我们设计了一个随机的，两组的，重复测量的设计，以测试一个为期两年的实验性干预措施，以提高护理质量，并随后提高居民的结果在养老院。需要改进的住院医生结果的设施将接受实验性多层次干预，以帮助工作人员（1）使用质量改进方法，（2）使用团队和团体流程进行直接护理决策，（3）专注于完成护理的基础知识，（4）保持更一致的护理和行政领导，致力于沟通和工作人员积极参与决策。多层次的干预将涉及所有级别的养老院工作人员，即业主，管理人员和直接护理人员在64个设施在三个州。我们将使用定性和定量方法来衡量干预措施的有效性。注意力控制组将收到有关老年人衰老和身体评估的信息。我们将从护理之家最小数据集中选择质量指标来衡量居民的结果：膀胱和肠失禁，体重减轻，压疮和日常生活活动（ADL）下降。我们将衡量员工保留;直接护理成本，总成本和详细成本;人员配置和员工组合，以及员工在干预之前，期间和之后对选定组织属性的看法。同样，我们将观察护理提供过程之前，期间和之后的多层次干预，以描述通过的护理提供策略中建议的干预。