Patient Centered Quality Reporting

描述（由申请人提供）：近几十年来，质量报告卡已成为美国医疗保健系统的重要组成部分。医疗保险和医疗补助服务中心（CMS）发布了一些基于网络的报告卡，包括养老院比较（NHC）。它为患者及其家属提供有关人员配备、缺陷和19项临床质量措施（QMs）的信息。这些报告的目的是告知消费者的选择和提高护理质量。关于他们成功实现这些目标的证据喜忧参半。迄今为止的研究表明，许多成绩单没有被广泛使用，或者根本没有被使用。考虑到信息的复杂性和养老院的选择通常是在时间限制和情绪紧张的情况下做出的这一事实，这并不奇怪，特别是当老年人必须出院时。

DESCRIPTION (provided by applicant): Quality report cards have become an important component of the American health care system in recent decades. The Centers for Medicare and Medicaid Services (CMS) publishes several web based report cards, including the Nursing Home Compare (NHC). It offers patients and their families' information about staffing, deficiencies, and 19 clinical quality measures (QMs). The objectives of these reports are to inform consumers' choice and improve quality of care. The evidence about their success in achieving these goals is mixed. Studies to-date suggests that many report cards are not widely used or not used at all. This is not surprising given both the complexity of the information and the fact that nursing home choices are typically made under both time constraints and in emotionally stressful situations, typically when the elder has to be discharged from the hospital. The objective of the proposed project is to develop and test a new e-coaching approach designed to take advantage of web technology and decision support software in order to facilitate and enhance access to and use of NHC. The Specific Aims of the project are: 1) To develop a consumer friendly web-based interface between NHC and an e-coaching/decision-aid tool. 2) To test its effectiveness through a randomized control trial. The project will be conducted at the University of California, Irvine Medical Center and will include medical and surgical patients identified by the attending as likely to be discharged to a nursing home. In year 1 we will develop a decision-aid tool, pilot test it with patients and families and build a web application that will integrate and interact with the NHC data guided by users' response to queries. In year 2 we will test the application we developed in the treatment group. The control group will continue with the usual discharge practice. Both groups will be surveyed. In year 3 survey data, data about the use patterns of the application, and data about the quality of nursing home destination facilities will be analyzed to test the study hypotheses. The lessons learned from this study will have direct application to improving the use of NHC by consumers. They may also be relevant to other report cards in the "Compare" series, Home Care Compare in particular.