Impact of Nursing Home Leadership Care Environments and Health Information Technology on Outcomes of Residents with Alzheimer's Disease and Related Dementias (ADRD)

疗养院领导护理环境和健康信息技术对阿尔茨海默病和相关痴呆症 (ADRD) 居民预后的影响

• 批准号: 10583354
• 负责人: Gregory L. Alexander
• 金额: $ 82.1万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-15 至 2027-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10583354
• 关键词: Administrator; Alzheimer' s disease related dementia; Black race; Caring; Characteristics; Chronic Disease; Clinical; Communication; Data; Dementia; Devices; Diagnosis; Discipline; Disparity; Elderly; Emergency department visit; Engineering; Environment; Health; Healthcare Systems; Home Nursing Care; Hospitalization; Intervention; Interview; Lead; Leadership; Length of Stay; Link; Long-Term Care Nursing; Mediating; Medicare claim; Medicine; Methods; Minority Groups; National Institute on Aging; Nurse Practitioners; Nursing Homes; Nursing Staff; Outcome; Ownership; Persons; Play; Provider; Quality of Care; Quality of life; Research; Resources; Risk; Role; Rural; Supportive care; Surveys; Technology; Testing; Training; Underrepresented Populations; United States; United States National Academy of Sciences; Visiting Nurse; Work; care coordination; care delivery; care outcomes; clinical care; dementia care; disparity reduction; enhanced care; ethnic health disparity; experience; health assessment; health difference; health disparity; health information technology; high risk; hospitalization rates; improved; improved outcome; informant; multiple chronic conditions; nursing care quality; nursing home length of stay; racial health disparity; restraint; trend

Our study examines the Impact of Nursing Home Leadership, Care Environments and Health Information Technology on Outcomes of Residents with Alzheimer’s Disease and Related Dementias (ADRD). Approximately 42% of 1.3 million nursing home (NH) residents have ADRD. NH residents with ADRD have frequent and longer length of stays than residents with other types of chronic illnesses. Nurse practitioners (NPs) are a predominant provider of NH care in the U.S. for residents with ADRD including 11,222 clinicians providing care in 5000 facilities. A growing strategy for improving resident outcomes is to effectively integrate health information technology (HIT) into NH care delivery. The use and integration of HIT into resident care, clinical support and administrative activities (known as HIT maturity) enhances care coordination and communication between NPs and staff, enabling NPs to manage resident health conditions better and improve resident outcomes. Evidence supports that NPs deliver higher quality care to residents in more positive care environments with supportive collegial relationships, greater access to resources and information. Studies focusing on care of NH residents with ADRD confirm that technology, shared communication, and care environments with clearly defined NP roles, helpful relationships, and supportive care lead to improved quality. We will examine the impact of NH HIT maturity and care environments on outcomes of residents with ADRD including hospitalizations and emergency department visits. Our specific aims are: 1) Provide comprehensive assessments of HIT maturity and NP care environments in NHs caring for residents with ADRD, 2) Examine the impact NH HIT maturity and NP care environments on disparities among residents with ADRD, and 3) Explore facilitators and barriers for achieving improved outcomes of residents with ADRD with diverse HIT maturity and care environments from the perspectives of NH administrators and NPs. During Aim 1 we will survey administrators and NPs from 1400 NHs collecting HIT maturity and care environment data from each discipline. We will link surveys to national NH data. We will assess differences in HIT maturity and NP care environments by NH characteristics. The association between HIT maturity and care environments will also be tested. During Aim 2 we will explore the potential mediating role of care environment on the relationship between HIT maturity and health outcomes. We will link surveys and resident level data (i.e. Medicare claims) during the same years’ surveys are conducted. During Aim 3 we will conduct key informant interviews with NH administrators (n = 70) and NPs (n = 70) representing diverse HIT maturity and care environments. Understanding HIT maturity and care environments where administrators and NPs work will help us identify methods to unlock their maximum potential to improve quality of NH care for residents with ADRD. We will identify differences in HIT maturity and care environments in NHs where administrators and NPs work, allowing us to identify targeted interventions that can be implemented to improve outcomes of residents with ADRD.

我们的研究考试疗养院领导，护理环境和健康信息技术对阿尔茨海默氏病和相关痴呆症（ADRD）的结果的影响。在130万护士住宅（NH）居民中，大约有42％的居民已有。与患有其他类型的慢性病的居民相比，ADRD的NH居民的住宿时间频繁且更长。护士从业人员（NPS）是美国ADRD居民的NH护理提供商，其中包括11,222名临床医生在5000个设施中提供护理。改善居民结果的策略不断增长，是将健康信息技术（HIT）有效地整合到NH护理交付中。在居民护理，临床支持和行政活动（称为成熟度）中使用和整合可增强NPS和员工之间的护理协调和沟通，使NPS能够更好地管理居民健康状况并改善居民的结果。证据支持，NP在具有支持性的大学关系的更积极的护理环境中为居民提供更高质量的护理，更多地获取资源和信息。专注于对NH居民进行护理的研究证实，具有明确定义的NP角色，有用的关系和支持性护理的技术，共享的沟通和护理环境可提高质量。我们将研究NH HIT成熟度和护理环境对ADRD居民结果的影响，以及3）探索促进者和障碍，以从NH管理员和NPS的角度从ADRD的居民改善ADRD的居民的结果。在AIM 1期间，我们将从每个学科中调查1400 NHS收集成熟度和护理环境数据的管理员和NP。我们将将调查与国家NH数据联系起来。我们将通过NH特征评估HIT成熟度和NP护理环境的差异。 HIT成熟度与护理环境之间的关联也将进行测试。在AIM 2期间，我们将探讨护理环境对命中至期与健康成果之间关系的潜在中介作用。我们将在同年的调查中链接调查和居民级别的数据（即医疗保险索赔）。在AIM 3期间，我们将对NH管理员（n = 70）和NP（n = 70）进行关键的线人访谈，代表发散的成熟度和护理环境。了解命中的成熟度和护理环境，在这些环境中，管理员和NPS的工作将有助于我们确定其最大潜力，以提高ADRD居民的NH护理质量。我们将确定管理员和NP工作的NHS的HIT成熟度和护理环境的差异，从而使我们能够确定可以实施的目标干预措施，以改善ADRD居民的结果。