Evidence-Based Medicine in the Skilled Nursing Facility

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DESCRIPTION (provided by applicant): Dr. Colon-Emeric aims to become an academic geriatrician and a nationally-recognized leader in improving the quality of care in nursing homes. Her initial work toward this goal has included the completion of a Masters of Health Science in Clinical Research, and research projects on fall and fracture prevention in nursing homes as a Brookdale National Geriatrics Fellow. With this Paul A. Beeson award she plans to progress from a semi-independent to an independent investigator as she acquires additional didactic training and research experience in both qualitative methodology and health services research. Her research program will be overseen by mentors with expertise in these areas including Dr. Kenneth Schmader, Dr. Morris Weinberger, and Dr. Ruth Anderson. The rich resources of the Duke University Center for Aging will be utilized in support of Dr. Colon-Emeric's development. Her research program includes two complementary projects with two specific aims: 1) Identify management practices, system characteristics, and provider beliefs that enhance or impede the use of evidence-based best practice in nursing homes; and 2) Develop and pilot test information technology systems interventions which promote evidence-based best practice in nursing homes. To achieve the first aim she will work with investigators on a NINR-funded case-study of high and low quality nursing facilities, utilizing both qualitative and quantitative methodology. Semi-structured interviews and focus groups will be conducted with nursing assistants, licensed nursing staff, medical staff, and administrators in 2 high-quality and 2 low-quality facilities. Interview probes will be constructed to elucidate the barriers and facilitators to evidence-based care for osteoporosis, falls, and fever evaluation in nursing facilities. Quantitative data from the larger case-study including facility quality indicators, resident-level quality of life data, network analyses and measures of information flow will be used. Analyses will describe systems and practices that should be emulated or discouraged in programs seeking to improve evidence-based practice. Building on these results, Dr. Colon-Emeric will then develop and pilot test an information technology system that provides evaluation and treatment options, decision-aids, and multidisciplinary educational tools encouraging evidence-based practice within an existing computerized order entry system. Common geriatric syndromes conditions (UTI, fever, osteoporosis, falls, and pneumonia) will be targeted, and both an academic and a community-based Veterans Administration Nursing Home Care Unit will be used.