Patient Centered Quality Reporting

描述(由申请人提供)：近几十年来，高质量的成绩单已成为美国医疗保健系统的重要组成部分。医疗保险和医疗补助服务中心(CMS)发布了几份基于网络的成绩单，包括疗养院比较(NHC)。它提供患者及其家人有关人员配备、不足之处和19项临床质量指标(QMS)的信息。这些报告的目的是告知消费者的选择和提高护理质量。他们成功实现这些目标的证据好坏参半。到目前为止的研究表明，许多成绩单并没有被广泛使用，或者根本没有使用。考虑到信息的复杂性，以及养老院选择通常是在时间限制和情绪紧张的情况下做出的，这并不令人惊讶，通常情况下，老人必须出院。 拟议项目的目标是开发和测试一种新的电子辅导方法，旨在利用网络技术和决策支持软件，以便利和加强接触和使用国家卫生中心。该项目的具体目标是：1)在国家卫生中心和电子辅导/决策辅助工具之间开发一个方便消费者的网络界面。2)通过随机对照试验验证其有效性。该项目将在加州大学欧文医学中心进行，将包括主治医生确定的可能被送往养老院的内科和外科患者。以年计 1我们将开发一个决策辅助工具，在患者和家属中进行试点测试，并构建一个Web应用程序，该应用程序将根据用户对查询的响应指导NHC数据并与其进行交互。在第二年，我们将测试我们在治疗组中开发的应用程序。对照组将继续通常的出院做法。这两组人都将接受调查。在第三年的调查数据中，将分析有关应用程序的使用模式的数据和关于疗养院目的地设施质量的数据，以检验研究假设。从这项研究中吸取的经验教训将直接应用于改善消费者对NHC的使用。它们也可能与“比较”系列中的其他成绩单相关，特别是家庭护理比较。 与公共健康相关：政府和私营组织发布质量成绩单，期望它们将告知消费者对供应商的选择，并增加对供应商提高质量的激励。这项研究将增强消费者获取成绩单信息并将其纳入决策过程的能力。这反过来又会增加成绩单的有效性。

DESCRIPTION (provided by applicant): Quality report cards have become an important component of the American health care system in recent decades. The Centers for Medicare and Medicaid Services (CMS) publishes several web based report cards, including the Nursing Home Compare (NHC). It offers patients and their families' information about staffing, deficiencies, and 19 clinical quality measures (QMs). The objectives of these reports are to inform consumers' choice and improve quality of care. The evidence about their success in achieving these goals is mixed. Studies to-date suggests that many report cards are not widely used or not used at all. This is not surprising given both the complexity of the information and the fact that nursing home choices are typically made under both time constraints and in emotionally stressful situations, typically when the elder has to be discharged from the hospital. The objective of the proposed project is to develop and test a new e-coaching approach designed to take advantage of web technology and decision support software in order to facilitate and enhance access to and use of NHC. The Specific Aims of the project are: 1) To develop a consumer friendly web-based interface between NHC and an e-coaching/decision-aid tool. 2) To test its effectiveness through a randomized control trial. The project will be conducted at the University of California, Irvine Medical Center and will include medical and surgical patients identified by the attending as likely to be discharged to a nursing home. In year 1 we will develop a decision-aid tool, pilot test it with patients and families and build a web application that will integrate and interact with the NHC data guided by users' response to queries. In year 2 we will test the application we developed in the treatment group. The control group will continue with the usual discharge practice. Both groups will be surveyed. In year 3 survey data, data about the use patterns of the application, and data about the quality of nursing home destination facilities will be analyzed to test the study hypotheses. The lessons learned from this study will have direct application to improving the use of NHC by consumers. They may also be relevant to other report cards in the "Compare" series, Home Care Compare in particular. PUBLIC HEALTH RELEVANCE: Quality report cards are published by governments and private organizations with the expectation that they will inform consumers' choice of providers and increase the incentives for providers to improve quality. This study will enhance the ability of consumers to access the information in report cards and incorporate it into their decision making process. This in turn will increase the effectiveness of report cards.