Multilevel Intervention to Improve Nursing Home Outcomes

描述(由申请人提供)：这项拟议的干预研究涉及计划公告、长期护理生活质量和护理质量。在这项研究中，我们试图通过将表现不佳的养老院员工转变为优秀的员工来改善居民的结果-这是一项紧迫的国家重要性任务。我们建议通过将从我们的初步工作中收集到的最佳临床和管理方法以及从其他组织(包括作为复杂适应系统的组织)以前支离破碎的一组研究中收集的最佳临床和管理方法来实现这一点。我们的干预将是全面的，它将是第一次在多个层面上工作：我们将与坚定地指导表现不佳的养老院的直接护理直接护理人员并肩工作，以促进他们采用优秀的护理系统和做法。我们还将培养专业和包容的护理管理风格和组织文化，拥抱持续改进，有系统地推进质量改进实践。基于我们最近完成的由NINR资助的研究，“养老院的护理过程、结果和成本”(1998-2003，Rantz，Pi)，我们设计了一项随机、两组、重复测量设计，以测试为期两年的实验干预，以提高护理质量，并随后改善养老院的住院结果。需要改善驻地成果的设施将接受实验性的多层次干预，帮助工作人员(1)使用质量改进方法，(2)使用团队和团体程序进行直接护理决策，(3)专注于完成基本护理，(4)保持更一致的护理和行政领导，致力于沟通和工作人员积极参与决策。多层次的干预将涉及各级养老院工作人员；即三个州的设施的所有者、管理人员和直接护理人员。我们将采用定性和定量相结合的方法来衡量干预的有效性。一个注意力控制小组将接受关于老年人衰老和身体评估的信息。我们将使用疗养院最低数据集中选定的质量指标来衡量住院结果：膀胱和肠道失禁、体重减轻、压疮和日常生活能力(ADL)下降。我们将衡量员工保留率；直接护理成本、总成本和详细成本；人员配置和员工组合，以及员工在干预前、干预期间和干预后对选定组织属性的看法。同样，我们将观察多级干预之前、期间和之后的护理提供过程，以描述干预中建议的护理提供策略的采用情况。

DESCRIPTION (provided by applicant): This proposed intervention study addresses the Program Announcement, Long-Term Care Quality of Life and Quality of Care. In this study, we seek to improve the outcomes of residents by transforming poorly performing nursing home staffs into good ones - a task of pressing national importance. We propose to accomplish this by bundling the best clinical and management approaches gleaned from our preliminary work and from a formerly fragmented set of studies by others, including organizations as complex adaptive systems. Our intervention will be comprehensive, and it will be the first to work at multiple levels: We will work side-by-side with the firmly guide direct-care direct care staff at poorly performing nursing homes to facilitate their adoption of excellent care systems and practices. We will also foster a professional and inclusive nursing management style and an organizational culture that embraces on-going improvement and systematically carries quality-improvement practices forward. Based on our recently completed NINR-funded study, "Nursing Care Processes, Outcomes and Cost in Nursing Homes" (1998-2003, Rantz, PI), we have designed a randomized, two-group, repeated-measures design to test a two-year experimental intervention for improving quality of care and subsequently improving resident outcomes in nursing homes. Facilities with resident outcomes in need of improvement will receive an experimental multilevel intervention that helps staff (1) use quality-improvement methods, (2) use team and group process for direct-care decision-making, (3) focus on accomplishing the basics of care and (4) maintain more consistent nursing and administrative leadership committed to communication and active participation of staff in decision-making. The multilevel intervention will involve all levels of nursing home staff; that is, owners, administrators and direct-care staff at 64 facilities in three states. We will use both qualitative and quantitative methods to measure the effectiveness of the intervention. An attention control group will receive information about aging and physical assessment of elders. We will measure resident outcomes with selected quality indicators from nursing home Minimum Data Set: bladder and bowel incontinence, weight loss, pressure ulcers and decline in activities of daily living (ADL). We will measure staff retention; direct-care costs, total costs, and detailed costs; staffing and staff mix, and employees' views of selected organizational attributes before, during and after the intervention. Similarly, we will observe processes of care delivery before, during and after the multilevel intervention to describe the adoption of the care delivery strategies recommended in the intervention.