Improving Quality of Care for Nursing Home Residents with Dementia

描述（由申请人提供）：痴呆症是一个关键的卫生保健和卫生政策问题，随着人口老龄化，它将变得更加重要和昂贵。我们在这项研究中的总体目标是提高护理质量的养老院居民与痴呆症通过严格审查和开发改进的一项重大政策举措-质量信息的公开报告-在护理过程和结果的影响养老院居民与痴呆症。养老院是痴呆症患者的主要护理场所，但几十年来，养老院部门一直受到质量问题的困扰。经过多年日益严格的监管未能将质量提高到可接受的水平，医疗保险和医疗补助服务中心于2002年推出了护理之家比较（NHC），这是一项公共报告计划，对美国所有医疗保险和医疗补助认证的护理之家进行了选定的护理方面的评估。新出现的证据表明，由于NHC，报告的临床质量发生了适度但积极的变化，美国政府继续投入资源进行这项工作。然而，痴呆症患者的护理与非痴呆症患者的护理有本质的不同。如果成绩单没有反映出对老年痴呆症疗养院居民最重要的质量方面，或者强调不适合他们的结果，他们可能不会从质量改善中受益，老年痴呆症护理的质量可能会下降。这取决于各设施是通过只针对所报告的措施的集中努力，还是通过目前尚不清楚的广泛的结构性变革，来针对公众报告寻求质量改进。尽管养老院是照顾老年痴呆症患者的主要提供者，但这一重大政策举措对照顾老年痴呆症患者的影响尚未得到评估。在这个项目中，我们的第一个目标是定量研究NHC对痴呆状态的居民水平的结果的影响，考虑到每个报告的措施，痴呆症居民的适当性或潜在的不适当性。我们还考虑了一些未报告的质量措施。我们的第二个目标是定性研究，使用半结构化的访谈管理人员和工作人员，如何养老院提供者认为他们的居民与痴呆症的质量，养老院追求的战略，以回应公众的报告，以及这些战略的影响-有意和无意-照顾居民与痴呆症。这些策略可能包括编码的变化和避免高风险的居民，以及各种方法来提高质量。我们的最终目标是评估几种可能性，以提高公共报告的能力，提高老年痴呆症居民的护理质量，包括现有措施的额外风险调整和可能纳入NHC的痴呆症适当的，但目前未报告的措施。 公共卫生相关性：我们在这项研究中的总体目标是提高护理质量的养老院居民与痴呆症通过严格审查和开发改进的一项重大政策举措-质量信息的公开报告-在护理质量的预期和非预期的影响养老院居民与痴呆症。痴呆症是一个关键的卫生保健和卫生政策问题，随着人口老龄化，它将变得更加重要和昂贵。

DESCRIPTION (provided by applicant): Dementia is a critical health care and health policy issue which promises to become even more important and costly as the population ages. Our overall goal in this study is to improve the quality of care for nursing home residents with dementia by critically examining and developing improvements to a major policy initiative -public reporting of quality information- in terms of the effects on processes and outcomes of care for nursing home residents with dementia. Nursing homes are a major site of care for persons with dementia, but the nursing home sector has been plagued with quality problems for several decades. After years of increasingly stringent regulation failed to raise quality to acceptable levels, the Centers for Medicare and Medicaid Services in 2002 launched Nursing Home Compare (NHC), a public reporting initiative that rates all Medicare- and Medicaid- certified nursing homes in the United States on selected aspects of care. Emerging evidence documents modest but positive changes in reported clinical quality as a result of NHC, and the US government continues to pour resources into this effort. However, care of demented residents is inherently different from care of non- demented residents. If report cards do not reflect aspects of quality most important to nursing home residents with dementia or emphasize outcomes that are not appropriate for them, they may not benefit from quality improvements and quality of dementia care may decline. This depends on whether facilities pursue quality improvement in response to public reporting through focused efforts directed only at the reported measures or through broad, structural changes, which is currently unknown. Despite the fact that nursing homes are a major provider of care to elderly individuals with dementia, the effects of this major policy initiative on care of persons with dementia have not been evaluated. Our first aim in this project is to examine quantitatively the effect of NHC on resident-level outcomes by dementia status, considering the appropriateness or potential inappropriateness of each reported measure for demented residents. We also consider several unreported measures of quality. Our second aim is to examine qualitatively, using semi-structured interviews with administrators and staff, how nursing home providers think of quality for their residents with dementia, the strategies that nursing homes pursue in response to public reporting, and the implications of these strategies- intended and unintended--for care of residents with dementia. These strategies may include coding changes and avoidance of high-risk residents as well as varied approaches to quality improvement. Our final aim is to evaluate several possibilities for improving the ability of public reporting to raise quality of care for residents with dementia, including additional risk-adjustment of existing measures and potential inclusion in NHC of dementia-appropriate but currently unreported measures. PUBLIC HEALTH RELEVANCE: Our overall goal in this study is to improve the quality of care for nursing home residents with dementia by critically examining and developing improvements to a major policy initiative -public reporting of quality information- in terms of the intended and unintended effects on quality of care for nursing home residents with dementia. Dementia is a critical health care and health policy issue which promises to become even more important and costly as the population ages.