Outcomes of Nursing Management Practice in Nursing Homes

疗养院护理管理实践的成果

• 批准号: 8069493
• 负责人: RUTH A ANDERSON
• 金额: $ 2.64万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-05-13 至 2011-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8069493
• 关键词: Accounting; Behavior; Behavior monitoring; Behavioral; Blinded; Caring; Case Study; Clinical; Clinical Trials; Cognitive; Collaborations; Communication; Complex; Decision Making; Decubitus ulcer; Discipline of Nursing; Educational process of instructing; Effectiveness; Elderly; Empirical Research; Failure; Fostering; Foundations; Frail Elderly; Frail Older Adults; Future; Health; Health Services Research; Healthcare; Home Nursing Care; Home environment; Incontinence; Individual; Intervention; Intervention Studies; Knowledge; Leadership; Learning; Long-Term Care Nursing; Measurement; Measures; Mediating; Medical; Mental Depression; Mentors; Modeling; Modification; Nursing Homes; Occupations; Outcome; Outcome Assessment; Outcome Measure; Outcome Study; Pain; Patients; Pattern; Population; Practice Management; Problem Solving; Process Measure; Provider; Publications; Quality of Care; Randomized; Recurrence; Reporting; Research; Risk Factors; Safety; Science; Social Problems; Syndrome; Techniques; Testing; Translating; Translational Research; Translations; Work; adverse outcome; arm; base; density; design; evidence base; fall risk; falls; improved; innovation; member; novel strategies; point of care; post intervention; programs; prospective; prototype; psychologic; routine practice; skills; theories

Project Summary Although several clinical trials have identified interventions that reduce adverse outcomes such as falls in nursing home (NH) residents, attempts to translate those interventions into practice using widely accepted quality improvement (QI) techniques have not been successful. Our previous R01, using a complexity science framework, has shown that low connection, information flow, and cognitive diversity among NH staff explains much of the poor quality of care delivered for complex problems such as falls. Additional pilot work showed that our "CONNECT" intervention fosters staff in learning to improve the density and quality of their interactions. CONNECT is a multi-component intervention based on our previous case study research that encourages staff to engage in network-building and use simple strategies to enhance information flow, connection among staff, and cognitive diversity. We hypothesize that high levels of connection, information flow and cognitive diversity are necessary before any QI intervention for a complex geriatric problem, such as falls, can be successful. This 5-year study will use a prospective, cluster-randomized, outcome assessment blinded design, with NHs (n=16) randomized to either CONNECT+FALLS or FALLS alone. We estimate that 560 residents and 576 staff members will participate. Specific aims are (1) Aim 1 (primary) Compare the impact of the CONNECT intervention plus a falls reduction QI intervention (CONNECT+FALLS) to the falls reduction QI intervention alone (FALLS), on fall-related outcome measures in NH residents; (2) Aim 2 (exploratory): Compare the impact of CONNECT+FALLS to FALLS alone on fall-related process measures in NH residents, and determine whether these mediate the impact on fall-related outcome measures. (3) Aim 3 (exploratory): Compare the impact of CONNECT+FALLS to FALLS alone on staff interaction measures, as reported by NH staff, and determine whether these mediate the impact on fall-related process measures and fall-related outcome measures. Measurements of staff interaction and residents' fall-related outcomes are taken at baseline, post intervention, 3 and 6 months. Fall rates and proportion of recurrent fallers is the primary study outcome. Exploratory measures include fall-related process measures and staff interaction measures (communication; participation, group-to-group interaction, psychological safety, and safety culture). Analysis will use a 3-level mixed model to account for the complex nesting of patients and staff within homes, and control for covariates associated with fall risk, including baseline facility fall rates. In order to promote the health of the frail NH population, it is essential to identify interventions to improve the translation of research advances into actual practice. The CONNECT intervention integrates behavioral/complexity science with principles of health services research, and has the potential to improve care in NHs for many complex medical and psycho-social problems among frail older adults.

项目摘要 尽管一些临床试验已经确定了减少不良结果（如福尔斯）的干预措施， 护理之家（NH）的居民，试图将这些干预措施转化为实践，使用广泛接受的 质量改进（QI）技术尚未成功。我们之前的R 01，使用了一个复杂的 科学框架，已经表明，低连接，信息流和认知多样性之间的NH工作人员 这解释了为诸如福尔斯等复杂问题提供的护理质量差的原因。额外试点工作 表明，我们的“健康教育”干预措施促进了工作人员学习，以提高他们的密度和质量， 交互. ECOECT是一种基于我们先前案例研究的多组分干预， 鼓励工作人员参与网络建设，并使用简单的战略来加强信息流动， 员工之间的联系和认知多样性。我们假设高水平的联系信息 在对复杂的老年问题进行任何QI干预之前，流动和认知多样性是必要的， 福尔斯能成功。 这项为期5年的研究将采用前瞻性、随机分组、结局评估设盲设计， NH（n=16）被随机分配至ECOECT+福尔斯或福尔斯单药治疗组。我们估计有560名居民和 将有576名工作人员参加。具体目标是：（1）目标1（主要） 降气干预加福尔斯降气干预（降气+降气）至福尔斯降气 单独干预（福尔斯），对NH居民跌倒相关结局指标;（2）目标2（探索性）： 在NH中，比较BLEECT+福尔斯与单独福尔斯对跌倒相关过程措施的影响 居民，并确定这些是否调解跌倒相关的结果措施的影响。(3)目标3 （探索性）：比较BLEECT+福尔斯与福尔斯单独对员工互动措施的影响， 并确定这些因素是否对跌倒相关过程措施的影响起中介作用 和跌倒相关的结果测量。工作人员互动和居民跌倒相关结果的测量 在基线、干预后、3个月和6个月时进行。跌倒率和复发性跌倒者的比例是 主要研究成果。探索性措施包括跌倒相关的过程措施和员工互动 措施（沟通、参与、群体间互动、心理安全和安全 文化）。分析将使用3级混合模型来解释患者和工作人员的复杂嵌套 在家中，并控制与跌倒风险相关的协变量，包括基线设施跌倒率。 为了促进脆弱的NH人群的健康，必须确定干预措施，以改善 将研究进展转化为实际实践。ECOECT干预整合了 行为/复杂性科学与卫生服务研究的原则，并有可能提高 护理在许多复杂的医疗和心理社会问题，在体弱的老年人。