COST-EFFECTIVE QUALITY--IMPROVING CLIENT OUTCOMES

拟议的四年项目的长期目标是改善 护理质量和疗养院的生活质量 居民以具有成本效益的方式。具体目标是： 1.确定住院医生的结果是否得到改善， 协议由APN针对以下常驻问题实现：a） 失禁，B）压疮，c）抑郁，和d）破坏性 行为（方案/APN仅干预） 2.确定住院医生是否使用方案/APN-仅干预 通过将APN纳入以下组织结构中， 作用：在职教育者，全组织质量的参与者 保证活动;以及工作人员顾问。（组织） 干预，第1阶段） 3.确定住院医生是否使用方案/APN干预加 组织干预，第1阶段通过增加 以下组织变化：护理大查房，质量 圈，以及在每个领域都有专业知识的内部资源团队， 协议.（组织干预，第二阶段） 4.确定高级实践中使用的科学衍生方案 护士降低了养老院护理的成本：a）居民; B）护理 3.第三方支付; 5.确定是否将组织干预措施添加到 协议/APN干预进一步降低了养老院护理的成本 对于a）居民，B）疗养院，和c）第三方付款人。 6.确定员工成果（工作满意度、离职率和认知 组织氛围）得到了改进 干预，协议/APN干预加上组织 干预阶段1，以及协议/APN干预加上 组织干预阶段2。 准实验设计将随机分配两种治疗， 对照三个养老院，这是可比的， 相关特征的数量。三组新入院的 每个机构的居民将构成样本（每个机构N = 108）。 要衡量的居民结果包括疗养院停留的时间，使用 急诊科、住院人数和住院天数， 压疮的存在和阶段， 失禁，精神状态，士气，抑郁的存在和程度， 破坏性行为的存在和程度、压力水平和功能 status.此外，还将收集居民和家庭的数据， 满意度、员工工作满意度、离职率、缺勤率和选定的 财政成果。研究结果将提供以下信息： 针对尿失禁、压力、 疼痛、抑郁和破坏性行为， 财政成果。此外，还将对居民进行比较， 执行和不执行科学推导的 APN协议以及添加和不添加组织 干预措施。

The long-term goal of the proposed four year project is to improve the quality of care and therefore the quality of life of nursing home residents in a cost-effective manner. The specific aims are to: 1. Determine if resident outcomes are improved when scientifically-derived protocols are implemented by APNs for the following resident problems: a) incontinence, b) pressure sores, c) depression, and d) disruptive behavior. (Protocol/APN Only Intervention) 2. Determine if resident outcomes using the Protocol/APN-Only Intervention are improved by the inclusion of the APN in the following organizational roles: inservice educator, participant in organization-wide quality assurance activities; and consultant to staff. (Organizational Intervention, Stage 1) 3. Determine if resident outcomes using the Protocol/APN Intervention plus the Organizational Intervention, Stage 1 are improved further by adding the following organizational changes: nursing grand rounds, quality circles, and in-house resource teams with expertise in each of the protocols. (Organizational Intervention, Stage 2) 4. Determine if scientifically-derived protocols used by advanced practice nurses reduce the costs of nursing home care for: a) residents; b) nursing homes, and c) third party payers. 5. Determine if the addition of Organizational Interventions to the Protocol/APN Intervention further reduces the cost of nursing home care for a) residents, b) nursing homes, and c) third party payers. 6. Determine if staff outcomes (job satisfaction, turnover, and perception of the organizational climate) are improved by the Protocol/APN-Only Intervention, the Protocol/APN Intervention plus the Organizational Intervention Stage 1, and the Protocol/APN Intervention plus the Organizational Intervention Stage 2. The quasi-experimental design will randomly assign the two treatments and the control to three nursing homes that are comparable with respect to a number of relevant characteristics. Three cohorts of newly admitted residents at each facility will comprise the sample (N= 108 per facility). Resident outcomes to be measured include length of nursing home stay, use of emergency department, number of hospitalizations and days hospitalized, Presence and stage of pressure sores, presence and frequency of incontinence, mental status, morale, presence and level of depression, presence and extent of disruptive behavior, stress level, and functional status. In addition, data will be obtained on resident and family satisfaction, staff job satisfaction, turnover, absenteeism, and selected fiscal outcomes. Findings from the study will provide information about the efficacy of specific intervention protocols for incontinence, pressure sores, depression, and disruptive behavior in terms of both resident and fiscal outcomes. In addition, comparisons will be made between resident outcomes with and without the implementation of scientifically-derived protocols by an APN and with and without the addition of organizational interventions.