Patient Safety in Nursing Homes: A Closer Look at Improvement

乍一看，最近在疗养院病人安全措施方面的改进， 政策的成功。据报道，疗养院居民患有压疮，福尔斯和尿失禁的百分比 自21世纪初以来，当政策制定者开始实施许多举措时， 注重提高养老院质量。然而，有人怀疑， 病人安全措施的表现真实地反映了住院医生的结果的改善，或者， 由于患者安全措施的数据是由以下人员自行报告的，因此仅反映了文件的变更 养老院对改善结果和最大限度地发挥患者效用感兴趣的决策者 安全措施也持这种怀疑态度，特别是在患者安全措施的性能 与其他既定质量指标的表现不匹配。最近纽约时报的几篇文章 引起了全国对这一问题的关注，强调了消费者感到被高质量误导的几个案例 选择养老院的评级远远低于预期。 报告的患者安全性改善是否反映了疗养院居民结局的真实改善 对养老院护理质量的差异具有特别重要的意义。众所周知，养老院与 很高比例的医疗补助居民，通常位于贫困社区， 少数种族和族裔群体成员提供的护理质量平均较低。虽然高- 在过去的两年里，医疗补助疗养院在许多病人安全措施方面都有显着的改善。 几十年来，如果这一表现不反映居民的福祉和成果，这些分数可能会掩盖 需要真实的质量改进，并没有做什么来解决养老院护理的差距。 我们在这项混合方法研究中的总体目标是评估养老院是否以及如何改善 患者安全，提供定量和定性证据，说明高性能和高 改善养老院达到这些分数。通过将这种表现与其他公认的 质量措施和潜在的改进机制，我们将深入了解这些措施是否 改善是否有意义，以及是否公平分配。为了实现前三个目标，我们 提议对2011-2014年多个合并数据集进行计量经济学分析。第四个目标将需要主要的 通过访谈和观察养老院收集定性数据。我们的结果将直接告诉 1)消费者应如何解读护理之家在患者安全措施方面的表现; 2）如何 政策制定者可能会完善这些措施，并确定养老院的措施， 可能不太可靠;以及3）有意义改进的最佳实践。

Recent improvements in measures of patient safety in nursing homes look, at first glance, like a monumental policy success. The reported percent of nursing home residents suffering pressure sores, falls, and urinary tract infections decreased dramatically since the early 2000s, when policymakers began numerous initiatives focused on improving nursing home quality. However, skepticism has emerged as to whether the improved performance on patient safety measures truly reflects improvements in residents’ outcomes or, alternatively, simply reflects changes in documentation since the data for the patient safety measures are self-reported by nursing homes. Policymakers interested in improving outcomes and maximizing the usefulness of the patient safety measures share this skepticism, especially in cases where performance on patient safety measures is not matched by performance on other established measures of quality. Several recent New York Times articles drew national attention to the issue, highlighting several cases where consumers felt misled by high quality ratings into choosing nursing homes that fell far short of expectations. Whether reported improvements in patient safety reflect true improvements in nursing home resident outcomes has particular import for disparities in the quality of nursing home care. It is well known that nursing homes with a high proportion of Medicaid residents, often located in poor neighborhoods and disproportionately serving members of racial and ethnic minority groups, provide lower quality of care on average. Although high- Medicaid nursing homes had notable improvements in many patient safety measures over the past two decades, if this performance does not reflect resident well-being and outcomes, these scores may mask the need for real quality improvement and do little to address disparities in nursing home care. Our overall objective in this mixed-methods study is to assess whether and how nursing homes are improving patient safety, providing both quantitative and qualitative evidence as to how high-performing and high- improving nursing homes achieve these scores. By correlating this performance with other well-established measures of quality and potential mechanisms for improvement, we will gain insight as to whether these improvements are meaningful and whether they are equitably distributed. To address the first three Aims, we propose econometric analysis of multiple merged data sets for 2011-2014. The fourth Aim will entail primary qualitative data collection through interviews and observation of nursing homes. Our results will directly inform 1) how consumers should interpret nursing home performance on patient safety measures; 2) how policymakers might refine the measures and identify nursing homes in which performance on the measures may be less reliable; and 3) best practices for meaningful improvement.