Improving the Quality of Care in Nursing Homes

描述（由申请人提供）：本修订提案是为了响应国家老龄化研究所共同发起的PA-02-162“长期护理接受者：生活质量和护理质量研究”而提交的。通过这项提案，希伯来老年康复中心与马萨诸塞州公共卫生部合作，实施并评估干预措施的有效性，以增加马萨诸塞州高质量疗养院的数量。该研究涉及在随机选择的养老院中进行3组干预，这些养老院在多个结果领域中总体表现不佳或处于最佳平均水平。我们称我们的计划为“SAVE”-代表可持续的活力和有效性。SAVE计划汇集了2种护理方法，1利用组织持续质量改进（CQI）系统，包括问题识别，循证护理和评估;第二种是针对特定结果领域实施特定护理协议。我们干预的3个组包括提供常规护理的对照组和2个积极治疗组，1个实施CQI编程（SAVE-CQI），第二个实施CQI程序和特定协议编程（SAVE-CQI+）。我们将从马萨诸塞州的养老院中取样，并将其纳入研究40，这些养老院在12个临床护理领域中的至少一些领域中证明了足够的数据质量，但在这些领域中具有次优结果。24例患者将随机分配至1个活性治疗组，16例患者将随机分配至常规护理对照组。我们将使用MDS数据记录的设施居民在15个月内，以衡量在假定的护理质量的变化，使用12个医疗保险和医疗补助服务中心的质量指标。公共卫生的重要性：这是一个雄心勃勃的项目，然而，在这个公共资源萎缩和人口结构变化的时代，这项研究的重要性被放大，导致越来越多的虚弱的老年人需要长期护理。干预本身的成本相对较低，因为它将由设施的现有工作人员实施，如果评估结果有利，可以使用现有资源在更多设施中实施。

DESCRIPTION (provided by applicant): This revised proposal is submitted in response to PA-02-162 "Long-Term Care Recipients: Quality of Life and Quality of Care Research" co-sponsored by the National Institute on Aging. With this proposal, the Hebrew Rehabilitation Center for Aged, in collaboration with the Massachusetts Department of Public Health, implement and evaluate the efficacy of an intervention to increase the number of high quality nursing homes in Massachusetts. The study involves mounting a 3 arm intervention in randomly selected nursing homes identified as performing in the aggregate at a poor or at best average level across multiple outcome domains. We call our program "SAVE" - standing for Sustaining Achievable Vitality and Effectiveness. The SAVE program brings together 2 approaches to care, 1 utilizing an organizational continuous quality improvement (CQI) system that includes problem recognition, evidence-based care, and evaluation; and the second the implementation of specific care protocols targeted at specific outcome areas. The 3 arms of our intervention include a control group delivering usual care, and 2 active treatment arms, 1 implementing the CQI programming (SAVE-CQI), the second implementing the CQI program and the specific protocol programming (SAVE-CQI+). We will sample from Massachusetts nursing homes and accrue to the study 40 that demonstrate adequate data quality but in, at least some of 12 clinical care areas, but have sub-optimal outcomes in these areas. 24 will be assigned randomly to 1 of the active treatment arms, and 16 to the usual care control condition. We will use MDS data for facility residents of record over a 15-month period to measure changes in presumed quality of care using 12 of the Centers for Medicare and Medicaid Services quality indicators. PUBLIC HEALTH IMPORTANCE: This is an ambitious project, however, the importance of the research is amplified in this era of shrinking public resources and demographic changes resulting increasing numbers of frail, older adults requiring residential long-term care. The intervention itself is relatively low cost, as it will be designed for implementation by a facility's existing staff, and could be implemented in a larger number of facilities using extant resources if the evaluation is favorable.