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.

乍一看，疗养院患者安全措施的最新改进看起来像是一个巨大的进步 政策的成功。据报告，疗养院居民中患有压疮、跌倒和泌尿道疾病的百分比 自 2000 年代初以来，决策者开始采取多项举措，肠道感染急剧下降 着力提升养老院品质。然而，人们对改进后的技术是否有效持怀疑态度。 患者安全措施的表现真正反映了居民治疗结果的改善，或者， 仅反映了文件的变化，因为患者安全措施的数据是由患者自行报告的 疗养院。政策制定者对改善结果和最大限度地发挥患者的用处感兴趣 安全措施也同样受到质疑，特别是在患者安全措施的执行情况不佳的情况下 与其他既定质量衡量标准的表现不相匹配。 《纽约时报》最近发表的几篇文章 提请全国关注这一问题，并强调了一些消费者因高质量而被误导的案例 选择养老院的评级远远低于预期。 报告的患者安全改善是否反映了疗养院居民治疗结果的真正改善 对于疗养院护理质量的差异尤其重要。众所周知，养老院设有 医疗补助居民比例很高，通常位于贫困社区且服务不成比例 少数种族和族裔群体的成员提供的护理质量平均较低。虽然高 过去两年，医疗补助疗养院在许多患者安全措施方面取得了显着改善 几十年来，如果这种表现不能反映居民的福祉和成果，这些分数可能会掩盖 需要真正提高质量，但在解决疗养院护理方面的差异方面却几乎没有采取任何措施。 我们在这项混合方法研究中的总体目标是评估疗养院是否以及如何改善 患者安全，提供定量和定性证据，说明高绩效和高绩效如何 改善疗养院达到这些分数。通过将此性能与其他成熟的性能相关联 质量措施和潜在的改进机制，我们将深入了解这些是否 改进是否有意义以及它们是否公平分配。为了实现前三个目标，我们 建议对 2011-2014 年多个合并数据集进行计量经济学分析。第四个目标将包括主要 通过访谈和观察疗养院收集定性数据。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，并确定疗养院的措施表现 可能不太可靠； 3) 有意义的改进的最佳实践。