Improving the Quality of Care in Nursing Homes

本修订提案是针对PA-02-162《长期护理受助者：生活质量》提出的 和护理质量研究“由国家老龄研究所共同赞助。有了这项建议， 希伯来老年康复中心，与马萨诸塞州公共卫生部合作， 实施和评估增加优质养老院数量的干预措施的效果 在马萨诸塞州。这项研究包括在随机选择的疗养院进行三臂干预 被确定为在多个结果中总体表现较差或最佳平均水平 域名。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。这个 SAVE计划结合了两种护理方法，一种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；以及 第二，执行针对特定成果领域的特定护理方案。的三只胳膊 我们的干预包括提供常规护理的对照组和两个积极的治疗武器，一个 实现CQI编程(SAVE-CQI)，第二个实现CQI程序和 特定协议编程(SAVE-CQI+)。我们将从马萨诸塞州的疗养院抽样并积累 到研究40，证明了足够的数据质量，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理想的。24人将被随机分配给其中一名现役人员 治疗武器，并将16人置于常规护理控制状态。我们将使用MDS数据为设施居民 使用12个中心在15个月的时间内记录以衡量假定护理质量的变化 对于Medicare和Medicaid服务质量指标。公共卫生重要性：这是一个 然而，这项雄心勃勃的计划在这个公众人数不断减少的时代放大了研究的重要性 资源和人口结构的变化导致越来越多的体弱多病的老年人需要居住 长期护理。干预措施本身的成本相对较低，因为它将由一个 设施的现有工作人员，并可以在使用现有资源的更多设施中实施，如果 评价是有利的。

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 three 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 two approaches to care, one utilizing an organizational continuous quality improvement (CQI) system that includes problem recognition, evidence-based care, and evaluation; and the second the implementation of^ecific care protocols targeted at specific outcome areas. The three arms of our intervention include a control group delivering usual care, and two active treatment arms, one 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 at, in least some of 12 clinical care areas, but have sub-optimal outcomes in these areas. Twenty-four will be assigned randomly to one 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 twelve 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.