Identifying Patient-Centered Fall Prevention Care Processes in Hip Fracture Rehabilitation

确定髋部骨折康复中以患者为中心的跌倒预防护理流程

• 批准号: 8889915
• 负责人: Natalie Elizabeth Leland
• 金额: $ 14.36万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8889915
• 关键词: Identifying; Patient; Centered; Fall; Prevention

 DESCRIPTION (provided by applicant): Dr. Natalie Leland is an occupational therapy researcher whose goal is to become an independent investigator in rehabilitation health services research, focusing on developing stakeholder-driven evidence-based quality measures, facilitating provider performance improvement, and enhancing patient-centered outcomes. The proposed award will facilitate this goal by expanding her competencies in stakeholder engagement, quality measure development, use of electronic health records, and healthcare policy. Dr. Leland will capitalize on the wealth of assets available at the University o Southern California, including nationally recognized NIH-funded mentors in gerontology, health policy, and economics. The goal of Dr. Leland's proposed K01 research is to develop patient-centered evidence-based quality measures of rehabilitation services in the area fall prevention. Such information is expected to minimize fall rates by defining gaps in rehabilitation documentation (and presumably rehabilitation practice) and thus informing opportunities for improving the quality of rehabilitation services. Despite preventative interventions that have the potential to decrease fall risk, post-acute care patients continue to fall, resulting in poor outcomes (e.g., rehospitalization) and unnecessary healthcare costs. As a result, there is serious concern about the extent to which evidence-based treatments are provided in rehabilitation settings. The most effective strategy for improving fall rates is to ensure the delivery and subsequent documentation of fall prevention interventions that are associated with high quality care. Primary care physicians have successfully implemented a protocol for the development of fall prevention quality measures, which begins by defining minimum standards for care, and has resulted in improved physician performance, and better patient outcomes. Thus, the first step towards improving outcomes for hip fracture patients in rehabilitation is to define the minimum standards of care so deficiencies in rehabilitation care can be identified and subsequently ameliorated. To ensure the development of stakeholder-driven quality measures, Dr. Leland will integrate qualitative and quantitative approaches to define high quality hip fracture rehabilitation for fall prevention. These findings will be used as preliminary data in a later R01 proposal using electronic health records from a nationally representative sample of rehabilitation providers in a longitudinal comparative effectiveness study. That study will evaluate the extent to which receipt of prioritized fall prevention care for hip fracture patients results in improved patient-centered outcomes. Defining the minimum standards of care for rehabilitation settings is a critical first step in facilitating high quality rehabilitation that dcreases falls. The current study is directly responsive to AHRQ's mission of improving the quality, safety, efficiency, and efficacy of health care for all Americans. Further, in drawing on the diversity of the older adult rehabilitation population in urban Los Angeles, multiple AHRQ priority populations will be included such as minorities, individuals with disabilities or multiple chronic conditions, and women.

 描述（由申请人提供）：Natalie Leland 博士是一名职业治疗研究员，其目标是成为康复健康服务研究的独立研究者，专注于制定利益相关者驱动的循证质量措施、促进提供者绩效改进以及增强以患者为中心的结果。拟议的奖项将通过扩大她在利益相关者参与、质量衡量标准制定、电子健康记录的使用和医疗保健政策方面的能力来促进这一目标的实现。 Leland 博士将利用南加州大学的丰富资源，包括国家认可的 NIH 资助的老年学、卫生政策和经济学导师。 Leland 博士提出的 K01 研究的目标是制定以患者为中心、基于证据的跌倒预防领域康复服务质量措施。此类信息有望通过确定康复文件（以及可能的康复实践）中的差距来最大限度地减少跌倒率，从而为提高康复服务质量提供机会。尽管预防性干预措施有可能降低跌倒风险，但急性后护理患者仍继续跌倒，导致预后不良（例如再次住院）和不必要的医疗费用。因此，人们对康复机构中提供循证治疗的程度感到严重关切。提高跌倒率的最有效策略是确保提供与高质量护理相关的跌倒预防干预措施并随后记录。初级保健医生已成功实施了制定跌倒预防质量措施的协议，该协议首先定义了最低护理标准，并提高了医生的表现和患者的治疗效果。因此，改善髋部骨折患者康复效果的第一步是确定最低护理标准，以便识别并随后改善康复护理中的缺陷。为了确保制定利益相关者驱动的质量措施，利兰博士将整合定性和定量方法来定义预防跌倒的高质量髋部骨折康复。这些发现将在后续的 R01 提案中用作初步数据，在纵向比较有效性研究中使用来自全国代表性康复提供者样本的电子健康记录。该研究将评估髋部骨折患者接受优先跌倒预防护理能在多大程度上改善以患者为中心的结果。确定康复环境的最低护理标准是促进高质量康复、减少跌倒的关键第一步。当前的研究直接响应 AHRQ 提高质量、安全、 所有美国人的医疗保健的效率和功效。此外，利用洛杉矶市区老年人康复人群的多样性，将纳入多个 AHRQ 优先人群，例如少数族裔、残疾人或多种慢性病患者以及妇女。