Post-Hospital Discharge Adverse Events in the Nursing Home Setting

 描述（由申请方提供）：拟定研究福尔斯处于长期护理、疗养院居民安全流行病学和可能导致疗养院环境中伤害减少的质量改进活动的交叉点。具体来说，我们将研究从疗养院环境过渡到急性护理环境的长期护理居民中发生的不良事件，然后出院回到同一设施。出于本研究的目的，不良事件定义为医疗护理对疗养院居民造成的伤害或损伤，包括未能提供所需的护理。的设置 这项工作将是从六个新英格兰州抽取的30家疗养院的代表性样本。本研究将与新英格兰质量创新网络-质量改进组织（NE QIN- QIO）合作进行。我们将利用一种实用的方法（触发工具方法）来可靠地识别、量化和表征不良事件。触发工具方法由医疗保健改善研究所开发，并采用“触发器”或线索来识别医疗记录中最终可能与伤害有关的不良事件。该方法已适用于广泛的临床环境。本研究的具体目的包括：（1） 描述长期入住疗养院居民出院后45天内不良事件的发生率、类型、严重程度和可预防性（长期住院= >100天）住院并返回同一设施;（2）确定人口统计学，临床，以及与发生后45天内发生的不良事件相关的功能性居民特征，住院并返回同一设施的疗养院居民的出院情况;（3）确定与发生后45天内发生的不良事件相关的设施级特征-住院并返回同一设施的疗养院居民的出院情况;以及（4）研究新英格兰地区国家护理之家质量护理合作组织的设施参与水平对住院并返回护理之家的护理之家居民中不良事件发生率的影响。同样的设施。这项研究的重点是设置的护理特点是可变的质量和人员，有限的医生参与，以及不一致的，往往不够重视病人的安全和护理质量问题。我们努力的长期战略取决于这样一种期望，即通过识别与极高风险出院后居民在疗养院发生的不良事件相关的安全问题，可以制定干预措施，以成功打击导致这一高度脆弱人群的次优护理和结局的系统。

 DESCRIPTION (provided by applicant): The proposed study falls at the intersection of long-term care, the epidemiology of nursing home resident safety, and quality improvement activities that may lead to the reduction of harm in the nursing home setting. Specifically, we will study adverse events that occur among long-term care residents who transition from the nursing home setting to an acute care setting, and then who are discharged back to the same facility. For the purpose of this study, an adverse event is defined as harm or injury to a nursing home resident as a result of medical care, including the failure to provide needed care. The setting for this work will be a representative sample of 30 nursing homes drawn from across the six New England states. The study will be conducted in collaboration with the New England Quality Innovation Network - Quality Improvement Organization (NE QIN- QIO). We will take advantage of a practical method (the trigger tool methodology) to reliably identify, quantify, and characterize adverse events. The trigger tool methodology was developed by the Institute for Healthcare Improvement and employs "triggers", or clues, to identify adverse events in medical records that can be ultimately linked to harm. The methodology has been adapted for use across a wide range of clinical settings. The specific aims of our study include the following: (1) to characterize the rates, types, severity, and preventability of adverse events that occur in the 45-day period post-hospital discharge among long-stay nursing home residents (long-stay = >100 days) who are hospitalized and return to the same facility; (2) to identify demographic, clinical, and functional resident characteristics associated with the occurrence of adverse events that occur in the 45-day period post-hospital discharge among nursing home residents who are hospitalized and return to the same facility; (3) to identify facility-level characteristics associted with the occurrence of adverse events that occur in the 45-day period post-hospital discharge among nursing home residents who are hospitalized and return to the same facility; and (4) to examine the impact of level of facility participation in the New England regional National Nursing Home Quality Care Collaborative on the occurrence of adverse events among nursing home residents who are hospitalized and return to the same facility. This study focuses on a setting of care characterized by variable quality and staffing, limited physician involvement, and inconsistent and often inadequate attention to patient safety and quality of care issues. The long range strategy underlying our efforts hinges on the expectation that by identifying safety concerns relevant to adverse events in nursing homes among residents during the very high-risk post-hospital discharge period, interventions may be developed to successfully combat systems that result in suboptimal care and outcomes in this highly vulnerable population.