Comparative effectiveness of home care environments for diverse elders' outcomes

描述（由申请人提供）：候选人是一名社区/公共卫生护士和老年卫生服务研究人员，致力于家庭健康服务系统的比较有效性研究。她的短期培训目标是（1）开发比较有效的研究方法的专业知识和（2）数据管理和分析方法，具体到家庭医疗保健数据集和研究设计问题。长期的研究目标是改善家庭健康护理结果的设计和提供，以适应快速老龄化和日益多样化的人口。除了重点研究，职业发展计划包括与她的指导/研究团队的同事互动，正式的课程工作将采取比较有效的研究方法。宾夕法尼亚大学将为她的职业发展提供良好的环境。资源包括访问著名的跨学科教师谁通过重点合作 研究中心在卫生服务研究，老龄化和比较有效性研究，在护理，医学，社会学，统计学和商业的学校。在优秀导师的指导下，在一流的培训环境中，通过访问丰富的数据集和强大的初步数据，该提案解决了三个具体目标：1）比较护理服务系统策略的有效性（更多的护士受过学士学位教育，护理访问的“前负荷”，和支持机构的工作环境），以改善家庭健康患者的结果~ 2）确定护理对家庭健康结果的影响是否以及在何种条件下取决于非正式护理人员的帮助~和3）确定家庭健康结果中种族/民族差异的程度，并确定哪些护理系统提供策略最有可能与改善种族/民族少数患者和临床复杂老年人的结果相关。 拟议的培训和研究将利用比较有效性研究方法的最新进展，以发现家庭健康结果中的种族/民族差异，了解促成因素（个人、家庭、社区和卫生系统），并评估 护理服务系统策略对改善不同个人和社会环境下的家庭健康患者的结果。这一创新项目将利用一个独特的数据集，包括护士调查，提供有关护理和家庭健康机构内的工作环境的详细信息，在近250个家庭健康机构，为生活在不同社区的老年人服务。护士调查结果与独立的家庭医疗保健患者评估和结果数据相结合，为每位患者的独特情况提供了一个窗口，包括其健康状况和护理需求的复杂性和严重性，以及有关其生活环境和非正式护理人员的信息。与其他行政和公共数据集的联系将提供更多的关键变量，涉及家庭保健机构的服务模式和社区对犯罪、隔离、社会经济地位和保健提供者的可用性/短缺的衡量。拟议的研究是重要的，因为它将突出不同的家庭健康护理服务策略的价值，以改善弱势群体中的病人的结果可能会实现。正在解决的挑战-如何最好地提供安全，有效和负担得起的家庭健康护理，以不同的患者-影响患者的结果，在整个护理的连续性，从家庭到医疗家庭和医院。有限的证据可用于指导家庭医疗保健系统管理员在家庭医疗护理提供系统战略的利弊作出决定。家庭健康护理服务提供策略的最佳组合可能是完全不同的，这取决于非正式的家庭照顾者和社区支持的存在。专业家庭健康护理和非正式（外行）或社区护理可以协同作用，以提高系统级干预的有效性，例如，通过降低所需服务的强度。提出的比较有效性研究将形成一个关键的证据，需要将有效的护理服务系统战略转化为基于证据的实践建议，提供者，付款人，购买者，政策制定者，其他主要调查人员和公众可以信任。

DESCRIPTION (provided by applicant): The candidate is a community/public health nurse and gerontological health services researcher committed to comparative effectiveness research on home health delivery systems. Her short-term training objectives are (1) to develop comparative effectiveness research methods expertise and (2) data management and analytic methods specific to home health care datasets and research design issues. Long term research goals are to improve the design and deliver of home health nursing care outcomes for a rapidly aging and increasingly diverse population. In addition to focused research, career development plans include interaction with colleagues on her mentoring/research team, formal course work will be taken in comparative effectiveness research methods. The University of Pennsylvania will provide an outstanding environment for her career development. Resources include access to eminent interdisciplinary faculty who collaborate through focused Research Centers in Health Services Research, Aging and Comparative Effectiveness Research, across the Schools of Nursing, Medicine, Sociology, Statistics, and Business. Guided by excellent mentors, in a superb training environment, with access to rich datasets and strong preliminary data, this proposal addresses three specific aims: 1) Compare the effectiveness of nursing delivery system strategies (more nurses educated at the baccalaureate level, "front-loading" of nursing visits, and supportive agency work environments) to improve home health patient outcomes~ 2) Determine if and under what conditions the impact of nursing on home health outcomes is contingent upon informal caregiver assistance~ and 3) Determine the extent of racial/ethnic disparities in home health outcomes, and determine which nursing system delivery strategies are most likely to be associated with improved outcomes for racial/ethnic minority patients and clinically complex older adults. The proposed training and research will utilize the latest advances in comparative effectiveness research methods to detect racial/ethnic disparities in home health outcomes, understand the contributing factors (individual, family, community and health systems), and evaluate the comparative effectiveness of nursing delivery system strategies on improving outcomes for home health patients under different individual and socio-environmental circumstances. This innovative project will capitalize on a unique data set, comprised of nurse surveys providing detailed information about nursing care and work environment within home health agencies in nearly 250 home health agencies that serve older adults living in diverse communities. The nurse survey results combined with independent home health care patient assessment and outcomes data provides a window into each patient's unique circumstances, including the complexity and severity of their health status and care needs, as well as information about their living environment and informal caregivers. Linkages with additional administrative and public datasets will provide additional key variables regarding home health agency service patterns and community measures of crime, segregation, socio-economic status and health care provider availability/shortages. The proposed research is significant because it will highlight the value of different home health nursing delivery strategie for improving patient outcomes among vulnerable populations may be achieved. The challenge being addressed--how to best provide safe, effective, and affordable home health nursing care to diverse patients--affects patient outcomes across the continuum of care from home to medical home and hospital. Limited evidence is available to guide home health care systems administrators in making decisions about the pros and cons of home health nursing delivery system strategies. The best combination of home health nursing care delivery strategies may be categorically different depending on the presence of informal family caregivers and community supports. Professional home health nursing care and informal (lay) or community care may interact synergistically to increase the effectiveness of systems level intervention, for example, by reducing the intensity of services needed. The comparative effectiveness study proposed will form a critical body of evidence needed to translate effective nursing delivery system strategies into evidence-based practice recommendations that providers, payers, purchasers, policy makers, other principle investigators, and the public can trust.