Improving Quality of Care for Persons with Dementia in Nursing Homes – Evaluation of the National Background Check Program

由于虐待、忽视和剥削，政策制定者和研究人员长期以来一直对养老院居民的福祉表示担忧。养老院的居民特别容易受到虐待和忽视，因为他们的年龄，以及身体和认知能力的下降。由于阿尔茨海默病（AD）和阿尔茨海默病相关痴呆（ADRD）患者的功能状况较差，认知障碍更严重，并且在日常活动中严重依赖照顾者，因此他们更有可能面临虐待和虐待。每年有超过20%的养老院被指虐待、忽视和剥削。国家背景调查计划（NBCP）是一项州级自愿计划，旨在减少包括养老院在内的长期护理机构对弱势居民的虐待、忽视和剥削。作为参与NBCP的项目要求的一部分，各州需要检查a)未来雇员居住的所有州的滥用登记，b)州犯罪历史记录，c)基于指纹的联邦调查局记录，以及d)州内任何其他可能有不合格信息的记录。联邦立法允许每个州获得高达300万美元的拨款来实施NBCP。自2010年以来，29个州和地区获得了资金，在不同的年份和处于不同的实施阶段实施国家行动纲领。然而，背景调查与虐待/住院治疗结果之间的联系尚不清楚。有证据表明，背景调查可能会在雇佣潜在的施虐者之前就发现他们。此外，背景调查也可能阻止潜在的施虐者申请养老院的工作。然而，背景调查可能不会抓住所有虐待者，NBCP的实施也可能导致劳动力短缺。我们的目标是通过AD/ADRD普查来评估NBCP在降低住院患者虐待、忽视和剥削以及改善养老院患者安全结果方面的有效性。为了实现这一目标，我们提出了三个具体目标的计量经济学分析：1)估计NBCP对虐待、忽视和剥削员工就业的影响；2)估计NBCP对虐待、忽视和剥削的引用的影响，总体上并根据AD/ADRD的高低进行分层；3)估计NBCP对不良患者质量结果的影响。营养不良、脱水、抑郁、跌倒、压疮、感染和抗精神病药物的使用，总体和AD/ADRD患者。研究结果将产生重要的新知识，说明NBCP在降低住院患者虐待、忽视和剥削以及改善养老院患者安全结果方面的有效性，以及对AD/ADRD患者的有效性。我们的研究结果有可能影响CMS对各州使用NBCP的政策，以改善AD/ADRD人群的预后。

Policymakers and researchers have long expressed concerns about resident wellbeing in nursing homes because of abuse, neglect, and exploitation. Nursing home residents are particularly susceptible to abuse and neglect because of their age, as well as physical and cognitive decline. Since individuals with Alzheimer ’s disease (AD) and Alzheimer’s Disease Related-Dementias (ADRD) have poorer functional status, more severe cognitive impairment, and are heavily dependent on caregivers for their daily activities, they are more likely to face abuse and mistreatment. Over 20% of nursing homes are cited for abuse, neglect, and exploitation every year. The National Background Check Program (NBCP) is a state-level voluntary program aimed at reducing abuse, neglect, and exploitation of vulnerable residents in long-term care settings including nursing homes. As part of the program requirements for participation in NBCP, states are required to check a) abuse registries of all states in which the prospective employee lived, b) state criminal history records, c) fingerprint-based FBI records, and d) any other records in the state that may have disqualifying information. Federal legislation allows each state to obtain up to $3 million in grants to implement NBCP. Since 2010, 29 states and territories have obtained the funding to implement NBCP over different years and are in various stages of implementation. However, link between background checks and abuse/resident outcomes is not clear. There is some evidence to show that background checks may catch potential abusers before they are hired. Moreover, background checks may also deter potential abusers from applying for jobs in nursing homes. However, background checks may not catch all perpetrators of abuse and implementation of NBCP may also lead to workforce shortages. Our objective is to evaluate the effectiveness of NBCP in lowering resident abuse, neglect, and exploitation and improving patient safety outcomes in nursing homes, overall, and by AD/ADRD census. To achieve this goal, we propose an econometric analysis for three specific aims: 1) To estimate the effect of NBCP on employment of staff who are guilty of abuse, neglect, and exploitation, 2) To estimate the effect of NBCP on citations for abuse, neglect, and exploitation, overall and stratified by high vs. low AD/ADRD census, and 3) To estimate the effect of NBCP on adverse patient quality outcomes: malnutrition, dehydration, depression, falls, pressure sores, infections, and utilization on antipsychotic drugs, overall and for individuals with AD/ADRD. The study results will yield important new knowledge about the effectiveness of NBCP in lowering resident abuse, neglect, and exploitation and improving patient safety outcomes in nursing homes, overall, and for persons with AD/ADRD. Our results have the potential to affect CMS policies on states’ use of NBCP to improve outcomes for AD/ADRD population.