Older adult safety while receiving home health services after hospital discharge

描述（由申请人提供）：老年人护理过渡期间的错误是常见的，昂贵的，有时甚至是致命的。护理过渡被定义为一个人从一个医疗机构到另一个医疗机构的移动，通常与不良后果有关。人口老龄化导致人们更加依赖家庭护理，而家庭护理是最常见和最不了解的医疗保健提供环境。出于尚不清楚的原因，那些需要熟练的家庭医疗保健（SHHC）服务的人（例如，家庭护理）是经历再入院风险最高的人群之一。需要针对医院/SHHC过渡的复杂性制定策略，以确保安全过渡，但指导改进工作的研究相对较少。拟议研究的总体目标是制定一个指数，供SHHC机构在真实的时间内使用，以识别和减少老年人在医院/SHHC过渡期间的安全风险。具体目标1：识别与以下方面相关的老年人安全潜在风险：（1）不同环境下SHHC提供者之间的信息管理，以及（2）建立老年人、护理人员和SHHC提供者在执行医疗保健任务时的角色。我们将使用前瞻性风险识别方法来识别潜在风险：（a）直接观察老年人医院/SHHC过渡;（B）对老年人/护理人员/SHHC提供者进行半结构化访谈。具体目标2：制定一个指数，SHHC机构将使用真实的时间，以确定在医院/SHHC过渡过程中老年人的安全风险有关的信息管理和建立的角色。通过焦点小组，SHHC供应商将根据其对确保安全的重要性及其发生频率对SA 1中确定的每种风险进行评级。具体目标3：评估心理测量学特性的指数，并确定使用的可行性。3a.评估SHHC提供者之间的指标评分者间的可靠性，并建立初始结构效度之间的护理过渡，质量不同。对于评分者间的可靠性，我们将确定由评估一系列护理过渡的SHHC提供者对计算的指数得分之间的相关性。对于结构效度，我们将比较护理过渡质量不同的病例之间的指数得分。3b.进一步评估结构效度使用不同的标准，并确定使用的可行性SHHC供应商。在出院后接受SHHC的老年人的前瞻性样本中，我们将确定SHHC提供者生成的指数评分与患者报告的护理过渡质量的一般指标（护理过渡指标，或CTM-3）之间的相关性。这项拟议的研究将填补对特别容易受到安全问题影响的老年人的护理过渡的理解方面的关键空白。研究结果有可能适用于更广泛的群体 从医院过渡到家庭并需要复杂护理的患者。

DESCRIPTION (provided by applicant): Errors during care transitions of older adults are common, costly, and sometimes lethal. A care transition is defined as the movement of a person from one healthcare setting to another and is commonly associated with adverse outcomes. The aging of the population is leading to greater reliance on care delivered in the home, the most common and poorly understood healthcare delivery setting. For unclear reasons, those who require skilled home healthcare (SHHC) services (e.g., home nursing) after hospital discharge are among those at highest risk of experiencing hospital readmission. Strategies tailored to the complexity of the hospital/SHHC transition are needed to ensure safe transitions, yet there is relatively little research to guide improvement efforts. The overall goal of the proposed study is to develop an index to be used by SHHC agencies in real time to identify and reduce potential risks to older adults' safety during hospital/SHHC transitions. SPECIFIC AIM 1: To identify potential risks to older adults' safety related to (1) information management among SHHC providers across settings, and (2) establishment of older adult, caregiver, and SHHC provider roles for execution of healthcare tasks. We will use prospective risk identification methods to identify potential risks: (a) direct observations of older adults' hospital/SHHC transition; and (b semi-structured interviews of older adults/caregivers/SHHC providers. SPECIFIC AIM 2: To develop an index that will be used by SHHC agencies in real time to identify risks to older adults' safety during hospital/SHHC transitions with regard to processes of information management and establishment of roles. Through focus groups, SHHC providers will rate each risk identified in SA1 on its importance to ensuring safety and its frequency of occurrence. SPECIFIC AIM 3: To evaluate psychometric properties of the index and ascertain feasibility of use. 3a. To evaluate index inter-rater reliability among SHHC providers and establish initial construct validity among care transitions that differ in quality. For inter-rater reliability, we wll determine the correlation between index scores calculated by pairs of SHHC providers evaluating a series of care transitions. For construct validity, we will compare index scores among cases that differ in care transition quality. 3b. To further evaluate construct validity usin a different standard and ascertain feasibility of use among SHHC providers. In a prospective sample of older adults receiving SHHC after hospital discharge, we will determine the correlation between SHHC provider-generated index scores and a general measure of patient-reported care transition quality (Care Transitions Measure, or CTM-3). The proposed study will fill critical gaps in the understanding of care transitions of older adults who are particularly vulnerable to safety issues. Study findings have the potential for applicability to a broader group of patients who transition from hospital to home and require complex care.