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将继续是患者，他们的家人和卫生保健政策制定者的主要关注点。在过去的20年里，联邦和州政府都在努力解决这些问题。这些措施包括实施标准的居民评估和护理规划工具，国家监管程序的改革，国家和国家出版物的养老院质量措施，国家质量改进活动的质量改进组织，以及最近的发展技术援助（TA）计划在许多国家旨在提供合作或非惩罚性的现场咨询，培训或与护理机构工作人员分享最佳做法。尽管作出了这些不同的努力，但许多质量问题仍然存在，这表明需要了解每一项举措的长处和短处。这项研究旨在测试国家发起的影响， TA计划及其潜力，以促进更好的养老院护理。各州的疗养院助教计划在计划结构方面存在很大差异（例如，人员配置模式）和过程（例如，是否与州监管机构共享电信局长对设施的访问结果）。因此，它们的有效性也可能各不相同。程序特性的自然变化为我们提供了 有机会研究国家TA计划的关键组成部分和高质量之间的关系 疗养院护理该项目的主要目标是通过确定有助于更好的养老院护理的州TA计划的各个方面来告知政策。具体的目的是测试的假设，国家TA计划的关键结构和过程特征与更好的风险调整后的健康结果的养老院居民和较低的情况组合调整后的缺陷引用。数据将从国家技术援助计划和几个二级数据库的调查收集。将使用多变量回归分析（包括工具变量分析）进行假设检验。公共卫生相关性：本研究将探讨国家技术援助计划的关键结构和过程组成部分对疗养院风险调整后的健康结果和病例组合调整后的缺陷引文的影响。我们将结合联合收割机从不同来源的数据，包括国家技术援助计划的调查，并使用统计回归技术，包括工具变量分析的假设检验。

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.