State Nursing Home Technical Assistance Programs: Variation & Impact on Quality

描述(由申请人提供)：疗养院的质量一直是并继续是患者、他们的家人和卫生保健政策制定者的主要关切。在过去的20年里，联邦和州政府都致力于解决这些问题。这些措施包括实施标准的居民评估和护理规划工具，改革州监管流程，国家和州发布养老院质量措施，质量改进组织开展全国质量改进活动，以及最近在许多州制定技术援助(TA)计划，旨在向护理机构工作人员提供协作性或非惩罚性的现场咨询、培训或分享最佳实践。尽管有这些不同的努力，许多质量问题仍然存在，这表明需要了解每一项倡议的优点和缺点。这项研究旨在测试启动的状态的影响 TA计划及其对更好的养老院护理做出贡献的潜力。养老院助教计划在计划结构(例如，人员配置模式)和流程(例如，助教访问设施的结果是否与州监管机构共享)方面因州而异。因此，它们的有效性可能也会有所不同。节目特点的自然变化为我们提供了 有机会研究国家助教计划的关键组成部分与高质量的关系 养老院护理。该项目的主要目标是通过确定国家助教计划中有助于更好地提供养老院护理的方面来为政策提供信息。具体目的是检验这样的假设，即州TA计划的关键结构和过程特征与养老院居民更好的风险调整后的健康结果和较低病例组合调整后的缺陷引用相关。数据将从州助教项目和几个二级数据库的调查中收集。包括工具变量分析在内的多元回归分析将用于假设检验。公共卫生相关性：这项研究将检查国家技术援助计划的关键结构和过程组成部分对养老院风险调整后的健康结果和病例组合调整后的缺陷引用的影响。我们将结合来自不同来源的数据，包括对州技术援助项目的调查，并使用统计回归技术，包括工具变量分析来进行假设检验。

DESCRIPTION (provided by applicant): Nursing home quality has been and continues to be a major concern for patients, their families, and health care policy makers. Over the last 2 decades, both the federal and state governments have engaged in efforts to address these concerns. These include the implementation of standard resident assessment and care planning tools, reforms of the state regulatory process, national and state publications of nursing home quality measures, national quality improvement activities by the Quality Improvement Organizations, and most recently the development of technical assistance (TA) programs in many states aimed at providing collaborative or non-punitive on-site consultation, training or sharing of best-practices with nursing facility staff. Despite these varied efforts, many quality problems persist, suggesting the need to understand the strengths and weaknesses of each of these initiatives. This study is designed to test the impact of the state initiated TA programs and their potential to contribute to better nursing home care. Nursing home TA programs vary substantially across states in terms of program structure (e.g., staffing pattern) and process (e.g., whether results of TA visits to facilities are shared with the state regulatory agency). Thus, their effectiveness is likely to vary as well. The natural variation in program characteristics offers us the opportunity to study the relationship between key components of the state TA program and high quality nursing home care. The main objective of the project is to inform policy by identifying aspects of the state TA program that contribute to better nursing home care. Specific aims are to test the hypotheses that the key structural and process characteristics of state TA programs are associated with better risk-adjusted health outcomes of nursing home residents and lower case mix adjusted deficiency citations. Data will be collected from survey of state TA programs and several secondary databases. Multivariate regression analyses including instrumental variable analysis will be used for hypothesis testing. PUBLIC HEALTH RELEVANCE: This study will examine the impact of the key structural and process components of state technical assistance programs on nursing home risk-adjusted health outcomes and case mix adjusted deficiency citations. We will combine data from different sources including a survey of state TA programs, and use statistical regression techniques including instrumental variable analysis for hypothesis testing.