Patient Safety in Nursing Homes: A Closer Look at Improvement

疗养院患者安全：仔细观察改进

• 批准号: 9348621
• 负责人: RITA TAMARA KONETZKA
• 金额: $ 49.21万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-30 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9348621
• 关键词: Patient; Safety; Nursing; Homes; Closer

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.

最近疗养院患者安全措施的改进，乍一看像是一个不朽的 政策成功。据报道，养老院居民患有压疮、跌倒和尿液的百分比 自21世纪初以来，呼吸道感染急剧下降，当时政策制定者开始了许多举措 着力提升养老院质量。然而，出现了一些怀疑，即是否改善了 患者安全措施的表现真正反映了住院医生结果的改善，或者， 仅反映文档中的更改，因为患者安全措施的数据由 养老院。政策制定者对改善结果和最大限度地发挥患者的作用感兴趣 安全措施也持这种怀疑态度，特别是在患者安全措施表现为 在其他既定质量指标上的表现不能与之匹敌。《纽约时报》最近的几篇文章 引起了全国对这一问题的关注，强调了几个消费者感觉被高质量误导的案例 选择远远低于预期的养老院的评级。 报道的患者安全性的改善是否反映了疗养院住院医生结果的真正改善 对于疗养院护理质量的差异具有特别重要的意义。众所周知，有养老院的 很高比例的医疗补助居民，通常位于贫困社区，提供不成比例的服务 种族和少数民族成员平均提供的护理质量较低。虽然很高- 在过去的两年里，医疗补助疗养院在许多患者安全措施方面都有了显著的改善 几十年来，如果这种表现不能反映居民的幸福感和结果，这些分数可能会掩盖 需要真正提高质量，对解决疗养院护理方面的差距几乎没有什么作用。 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 改进的养老院达到了这些分数。通过将这种表现与其他久负盛名的 质量措施和潜在的改进机制，我们将深入了解这些 改进是有意义的，以及它们是否公平分配。为达致首三个目标，我们 建议对2011-2014年的多个合并数据集进行计量经济分析。第四个目标将是主要目标 通过对养老院的访谈和观察收集定性数据。我们的结果将直接告知 1)消费者应如何解读疗养院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，并确定哪些养老院在这些措施上表现良好 可能不那么可靠；以及3)有意义的改进的最佳实践。