Examining the Relationship of Culture Change, Adverse Events and Costs in CLCs

检查 CLC 中文化变革、不良事件和成本的关系

• 批准号: 8392492
• 负责人: Jennifer L Sullivan
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-03-01 至 2016-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8392492
• 关键词: Adoption; Adverse event; Area; Budgets; Caring; Categories; Characteristics; Collection; Cost Control; Cross-Sectional Studies; Data; Data Set; Electronics; Environment; Family; Funding; Future; Goals; Grant; Guidelines; Health system; Home Nursing Care; Home environment; Individual; Infection Control; Institute of Medicine (U.S.); Integrated Delivery Systems; Intervention; Lead; Leadership; Learning; Life; Long-Term Care; Longitudinal Studies; Measurement; Measures; Methods; Modeling; Morphologic artifacts; Movement; Names; Nursing Homes; Outcome; Paper; Patients; Performance; Performance Status; Physical environment; Policies; Positioning Attribute; Private Sector; Process; Publishing; Quality Indicator; Quality of Care; Quality of life; Reporting; Research; Research Infrastructure; Research Personnel; Role; Scoring Method; Series; Shapes; Signal Transduction; Site; Site Visit; System; Time; Variant; Veterans; Work; base; community living; cost; design; evidence base; health administration; holistic approach; improved; infancy; operation; person centered; pressure; success; tool

DESCRIPTION (provided by applicant): Research Objectives: The purpose of our proposed longitudinal mixed-methods study is to build on our initial work by analyzing relationships over time (2008-2014), which will allow us to understand the effects of PCC on quality and quality on costs and develop a better understanding about variations in PCC/quality and characteristics distinguishing CLCs with higher levels of PCC implementation. Our specific objectives are to: 1) examine whether the level of implementing PCC is associated with higher quality (fewer adverse events) over time as measured by a set of 28 MDS QIs; 2) examine whether higher facility-level quality is associated with lower patient-level costs; and 3) identify key structural and organizational characteristics, and PCC implementation and quality processes that distinguish CLCs providing high PCC and quality from other CLCs where PCC and quality performance is lower (mixed or low) in both domains by conducting site visits at selected facilities. Project Background/Rationale: PCC implementation underway in VA, combined with the use in VA of both the Artifacts Tool and MDS-based QIs, represents a unique research opportunity (supported by VA operations) to assess the impact of implementing PCC on quality in a large, integrated delivery system with a sizable number of sites. Using cross-sectional data, we have found that there is a statistically significant relationship between the extent of PCC and an MDS- based composite measure of quality; and, there is preliminary evidence that higher levels of quality are associated with lower costs. This study will allow us to 1) identify the extent to which PCC implementation leads to lower adverse event rates; 2) identify the extent to which quality leads to costs; and 3) understand what distinguishes the high from the low performing CLCs. Dr. Christa Hojlo has emphasized that PCC implementation, quality, and costs are all important areas for researchers to study in order to build an evidence-base in the VA for CLC quality improvement and inform and shape practice. Project Methods: In Objective 1, we will 1) measure PCC implementation by assessing Artifacts Tool scoring methods and evaluating alternative summary scores and latent scores; 2) measure quality by creating a composite score using facility-level data on 28 MDS QIs data; 3) evaluate the relationship between the MDS-based quality composite score and Artifact Tool PCC scores using a Bayesian model; and 4) evaluate the relationship between the individual MDS-based quality indicators and Artifact Tool PCC scores using a Bayesian model. In Objective 2, we will examine if higher quality is associated with lower patient-level costs through both individual and time-series regressions as well as through Bayesian modeling. Finally in Objective 3, we will conduct twelve site visits in order to understand variations in key health systems factors (structural characteristics, PCC/quality processes, and organizational infrastructure) for CLCs in high performance versus low and mixed performance categories. Sites will be selected according to their performance status (PCC implementation and Quality).

描述（由申请人提供）： 研究目的：我们提出的纵向混合方法研究的目的是建立在我们的初步工作，通过分析随着时间的推移（2008-2014年），这将使我们能够了解PCC对质量和质量对成本的影响，并制定一个更好地了解PCC/质量和特点的变化区分CLC与PCC实施水平较高。我们的具体目标是：1）研究实施PCC的水平是否与更高的质量相关（较少的不良事件）随着时间的推移，如通过一组28个MDS QIs测量的; 2）检查较高的设施水平质量是否与较低的患者水平成本相关;以及3）确定关键的结构和组织特征，以及PCC实施和质量流程，通过在选定的设施进行现场访问，将提供高PCC和质量的CLC与PCC和质量性能较低（混合或低）的其他CLC区分开来。项目背景/依据：在VA中实施PCC，结合在VA中使用Artifacts Tool和基于MDS的QIs，代表了一个独特的研究机会（由VA运营支持），以评估实施PCC对具有相当数量站点的大型综合交付系统质量的影响。使用横截面数据，我们发现PCC的程度和基于MDS的综合质量测量之间存在统计学显著关系;并且，初步证据表明，较高的质量水平与较低的质量水平相关。 成本这项研究将使我们能够：1）确定PCC实施导致不良事件发生率降低的程度; 2）确定质量导致成本的程度; 3）了解高性能CLC与低性能CLC的区别。Christa Hojlo博士强调，PCC的实施，质量和成本都是研究人员研究的重要领域，以便在VA中建立CLC质量改进的证据基础，并为实践提供信息和塑造实践。项目方法：在目标1中，我们将1）通过评估伪影工具评分方法和评估替代汇总评分和潜在评分来衡量PCC实施情况; 2）通过使用28个MDS QIs数据的设施级数据创建综合评分来衡量质量; 3）使用贝叶斯模型评估基于MDS的质量综合评分与PITTTool PCC评分之间的关系;以及4）使用贝叶斯模型评估各个基于MDS的质量指标与MPTool PCC分数之间的关系。在目标2中，我们将通过个体和时间序列回归以及贝叶斯建模来检查更高的质量是否与更低的患者水平成本相关。最后，在目标3中，我们将进行12次现场访问，以了解关键的 卫生系统因素（结构特征，PCC/质量流程和组织基础设施）CLC在高性能与低性能和混合性能类别。将根据其绩效状态（PCC实施和质量）选择研究中心。