Specialization in Nursing Home Care

疗养院护理专业

• 批准号: 9217536
• 负责人: DAVID C GRABOWSKI
• 金额: $ 27.8万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-02-15 至 2019-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9217536
• 关键词: Acute; Antidepressive Agents; Caring; Characteristics; Chronically Ill; Communities; Data; Data Set; Dementia; Exhibits; Growth; Health; Health Services Research; Healthcare; Home Nursing Care; Home environment; Hospitals; Impaired cognition; Impairment; Lead; Learning; Literature; Long-Term Care; Medicare claim; Mental Health; Mental disorders; Methods; Nursing Assessment; Nursing Homes; Outcome; Patients; Persons; Policies; Population; Prevalence; Procedures; Process Measure; Provider; Quality Indicator; Quality of Care; Randomized; Research; Research Personnel; Scientist; Series; Testing; Time; Variant; Vulnerable Populations; care seeking; disadvantaged population; experience; functional disability; functional improvement; high standard; improved; improved outcome; instrument; interest; medical specialties; public health relevance; severe mental illness; social; study population

DESCRIPTION (provided by applicant): Historically, nursing homes were functionally similar, caring for impaired residents with a range of underlying health conditions largely drawn from the local community. Over time, however, homes have specialized in the treatment of particular types of chronically ill residents. In particular, some homes now specialize in the treatment of residents with dementia and/or severe mental illness. This specialization occurs both by treating a high volume of residents with these conditions and also through dedicated units and facilities. The literature to date on specialization in nursing home care has largely been confounded by differential selection into more and less specialized settings. The type of resident who is admitted to a dementia special care unit (SCU), for example, may be quite different in many unobserved ways from the resident who is admitted to a non-SCU facility. If so, simple comparisons of quality of SCU and non-SCU settings, controlling for observable characteristics, may yield misleading estimates. When randomization is not feasible, as in this case, social scientists have applied instrumental variables methods to account for unobserved differences across study populations. One "instrument" that has been frequently and successfully used in health care, including in the PI's prior nursing home research, is the differential distance from the patient's home to different providers. Using instrumental variables methods, the research proposed here seeks to test hypotheses pertinent to the question of whether specialization by nursing homes in the treatment of mental illness or dementia improves outcomes. We focus on these two conditions because of their prevalence and the observed specialization by nursing homes in the treatment of these populations. Thus, these conditions provide an ideal opportunity to study the positives and negatives of nursing home specialization. In Aim 1, we investigate the within and between-facility variation in care for persons with dementia or mental illness in nursing homes. That is, across homes and within a home, do persons with dementia and mental illness receive comparable quality of care? Aim 2 focuses on the independent effect of specialization on quality. If specialization is associated with expertise, this specialization wll improve care, if it is associated with worse care being offered to a disadvantaged population, the effect of specialization will be negative. Aim 3 recognizes that the care of persons with mental illness or dementia may exhibit externalities. We quantify the spillovers in quality for car of other residents. In all three Aims, we focus on empirical indicators of quality of care, measured by process and outcome indicators, for both general and mental health care. We use the powerful national 1999-2011 Minimum Data Set (MDS) assessments of nursing home residents merged with Medicare claims data. By providing the best evidence to date on specialization in the treatment of residents with mental illness and dementia, this proposal has the potential to greatly improve the quality of care for the millions of residents with dementia an mental illness that will be treated in U.S. nursing homes in the coming decade.

描述（由申请人提供）：从历史上看，疗养院在功能上相似，照顾受损的居民，这些居民在很大程度上从当地社区汲取了一系列潜在的健康状况。但是，随着时间的流逝，房屋专门治疗特定类型的慢性病居民。特别是，一些房屋现在专门治疗痴呆症和/或严重精神疾病的居民。这种专业是通过处理这些条件的大量居民以及专用的单位和设施来进行的。迄今为止，关于疗养院护理专业化的文献在很大程度上被差异化的选择与更多专业的环境相混淆。例如，接受痴呆症特殊护理部门（SCU）的居民类型在许多毫无观察的方式上与被接纳为非SCU设施的居民可能完全不同。如果是这样，则简单地比较了SCU和非SCU设置的质量（控制可观察的特征）可能会产生误导性的估计。当随机分组不可行时，就像在这种情况下一样，社会科学家应用了工具变量方法来解释研究人群之间未观察到的差异。从患者的家到不同提供者的差异距离，包括在PI先前的疗养院研究中经常和成功使用的一种“仪器”，包括在PI之前的疗养院研究中。使用仪器变量方法，此处提出的研究试图检验与疗养院在治疗精神疾病或痴呆症治疗中专业化的问题有关的问题。我们专注于这两种情况，因为它们的流行率和疗养院在治疗这些人群中的专业化。因此，这些条件为研究疗养院专业化的积极和负面影响提供了理想的机会。在AIM 1中，我们调查了疗养院患有痴呆症或精神疾病患者的护理内部和诊所之间的差异。也就是说，跨家庭和家庭内部，患有痴呆症和精神疾病的人会获得可比的护理质量吗？ AIM 2专注于专业对质量的独立影响。如果专业化与专业知识相关，那么这种专业化会改善护理，如果它与不利的人群提供的护理相关，那么专业的影响将是负面的。 AIM 3认识到，精神疾病或痴呆症患者的护理可能表现出外部性。我们量化了其他居民汽车的质量溢出。在所有三个目标中，我们都专注于一般和心理保健的经验指标，以过程和结果指标来衡量。我们使用强大的国家1999 - 2011年最低数据集（MDS）评估疗养院居民与Medicare索赔数据合并的评估。通过提供迄今为止专业治疗精神疾病和痴呆症居民的最佳证据，该提案有可能极大地提高数百万患有痴呆症的居民的护理质量，这将在未来十年中在美国疗养院接受治疗。