Understanding Processes of Care and Patient Safety Outcomes in Nursing Homes: An

描述（由申请人提供）：居民的安全和居民护理是疗养院提供的护理质量不可或缺的。研究表明，病人安全文化，定义为一个协调一致的组织努力走向安全的结果，是欠发达的养老院和病人的安全文化得分往往比医院低得多。因此，养老院的居民可能有受到伤害的风险。很少有研究探讨病人的安全在疗养院，尽管越来越认识到的重要性，了解什么预测更有利的水平，病人的安全。特别是，需要证据来确定护理之家的病人安全文化在避免不良居民结果中所起的作用。使用修订版的多纳贝迪安的结构-过程-结果（SPO）模型，其中还包括组织属性，如文化，本研究探讨高层管理人员的评级之间的关系的护理之家病人安全文化（结构属性），和客观措施的安全过程的护理和居民的成果。为了完成二级数据分析，本项目将利用三个数据源：1）2008年由来自4000家美国养老院的全国代表性样本的养老院管理者和护理主任完成的医疗保健研究和质量养老院患者安全文化调查，2）来自2008年在线调查认证和报告数据库的数据，（3）2008年最小数据集。住院医师的约束使用和导管插入术将被用作过程的测量，压疮、福尔斯和尿路感染将被用于测量患者安全性结局。为了研究护理之家的患者安全文化是否与护理过程和患者安全结果相关，本研究将利用先进的统计方法对多层次数据进行建模，即两级分层广义线性模型。最终目标是通过理解专注于安全，护理流程和患者安全结果的文化之间的关系，找到提高医疗保健质量的方法。这些初步的研究结果有望有助于在疗养院发展病人安全文化，并促进医疗保健的改善，可以通过护理过程和住院医生的结果来衡量。 公共卫生相关性：病人安全是一个重要方面的护理家庭护理和有越来越多的认识，了解什么预测更高水平的病人安全的重要性。特别是，需要证据来确定护理之家的病人安全文化在避免不良居民结果中所起的作用。因此，了解患者安全文化、护理过程和患者安全结果之间的关系非常重要。

DESCRIPTION (provided by applicant): The safety of residents and resident care are integral to the quality of care provided in nursing homes. Studies have shown that patient safety culture, defined as the outcome of a concerted organizational effort to move towards safety, is poorly developed in nursing homes and patient safety culture scores tend to be considerably lower than those of hospitals. Therefore, residents of nursing homes may be at risk of harm. Few studies have examined patient safety in nursing homes despite the growing recognition of the importance in understanding what predicts more favorable levels of patient safety. In particular, evidence is needed to ascertain the role nursing home patient safety culture plays in avoiding adverse resident outcomes. Using the revised version of Donabedian's Structure-Process-Outcome (SPO) Model, which also includes organizational attributes such as culture, this study examines the relationships between top management's ratings of nursing home patient safety culture (a structural attribute), and objective measures of safe processes of care and resident outcomes. To complete this secondary data analysis, this project will utilize three data sources: 1) the Agency for Healthcare Research and Quality Nursing Home Survey on Patient Safety Culture completed in 2008 by nursing home administrators and directors of nursing from a nationally representative sample of 4000 U.S. nursing homes, 2) data from the 2008 Online Survey Certification and Reporting Database, and 3) the 2008 Minimum Data Set. Restraint use and catheterization of residents will be used as measures of processes, and pressure sores, falls, and urinary tract infections will be used to measure patient safety outcomes. To examine if the patient safety culture of nursing homes is related to processes of care and patient safety outcomes, this study will utilize an advanced statistical approach to model multilevel data, namely two-level hierarchical generalized linear models. The ultimate goal is to find ways to improve the quality of health care through an understanding of the relationship between a culture focused on safety, care processes, and patient safety outcomes. These first research findings hopefully should contribute to the development of a patient safety culture in nursing homes and promote improvements in health care that can be measured by processes of care and resident outcomes. PUBLIC HEALTH RELEVANCE: Patient safety is a critical aspect of nursing home care and there is a growing recognition of the importance in understanding what predicts higher levels of patient safety. In particular, evidence is needed to ascertain the role nursing home patient safety culture plays in avoiding adverse resident outcomes. Therefore, it is important to understand the relationship of patient safety culture, processes of care, and patient safety outcomes.