Improving the Quality of Care in Nursing Homes

描述(由申请人提供)：本修订提案是应国家老龄研究所共同赞助的PA-02-162“长期护理接受者：生活质量和护理质量研究”而提交的。根据这一建议，希伯来老年康复中心与马萨诸塞州公共卫生部合作，实施并评估了增加马萨诸塞州高质量养老院数量的干预措施的效果。这项研究涉及在随机选择的疗养院中进行三臂干预，这些疗养院被确定为在多个结果领域中总体表现较差或最佳平均水平。我们把我们的计划称为“拯救”--意为保持可实现的活力和有效性。SAVE计划汇集了两种护理方法，一是利用组织的持续质量改进(CQI)系统，包括问题识别、循证护理和评估；二是针对特定结果领域实施特定的护理方案。干预的3个手臂包括提供常规护理的对照组和2个积极治疗手臂，1个实施CQI计划(SAVE-CQI)，第二个实施CQI计划和特定方案编程(SAVE-CQI+)。我们将从马萨诸塞州的疗养院抽样，并积累到研究40，这些研究证明数据质量足够，但至少在12个临床护理领域中的一些领域，但在这些领域的结果不是最优的。24人将被随机分配到1个现役治疗组，16人被分配到通常的护理控制条件下。我们将使用15个月内有记录的设施居民的MDS数据，使用医疗保险和医疗补助服务中心的12个质量指标来衡量假定护理质量的变化。公共卫生重要性：这是一个雄心勃勃的项目，然而，在这个公共资源缩水和人口结构变化导致越来越多需要长期护理的虚弱老年人的时代，这项研究的重要性被放大了。干预措施本身的成本相对较低，因为它将由设施的现有工作人员实施，如果评估结果有利，可以利用现有资源在更多的设施中实施。

DESCRIPTION (provided by applicant): This revised proposal is submitted in response to PA-02-162 "Long-Term Care Recipients: Quality of Life and Quality of Care Research" co-sponsored by the National Institute on Aging. With this proposal, the Hebrew Rehabilitation Center for Aged, in collaboration with the Massachusetts Department of Public Health, implement and evaluate the efficacy of an intervention to increase the number of high quality nursing homes in Massachusetts. The study involves mounting a 3 arm intervention in randomly selected nursing homes identified as performing in the aggregate at a poor or at best average level across multiple outcome domains. We call our program "SAVE" - standing for Sustaining Achievable Vitality and Effectiveness. The SAVE program brings together 2 approaches to care, 1 utilizing an organizational continuous quality improvement (CQI) system that includes problem recognition, evidence-based care, and evaluation; and the second the implementation of specific care protocols targeted at specific outcome areas. The 3 arms of our intervention include a control group delivering usual care, and 2 active treatment arms, 1 implementing the CQI programming (SAVE-CQI), the second implementing the CQI program and the specific protocol programming (SAVE-CQI+). We will sample from Massachusetts nursing homes and accrue to the study 40 that demonstrate adequate data quality but in, at least some of 12 clinical care areas, but have sub-optimal outcomes in these areas. 24 will be assigned randomly to 1 of the active treatment arms, and 16 to the usual care control condition. We will use MDS data for facility residents of record over a 15-month period to measure changes in presumed quality of care using 12 of the Centers for Medicare and Medicaid Services quality indicators. PUBLIC HEALTH IMPORTANCE: This is an ambitious project, however, the importance of the research is amplified in this era of shrinking public resources and demographic changes resulting increasing numbers of frail, older adults requiring residential long-term care. The intervention itself is relatively low cost, as it will be designed for implementation by a facility's existing staff, and could be implemented in a larger number of facilities using extant resources if the evaluation is favorable.