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.

本研究探讨养老院领导、护理环境及健康资讯科技对阿兹海默病及相关失智症（ADRD）患者预后的影响。130万疗养院（NH）居民中约有42%患有ADRD。与患有其他类型慢性疾病的居民相比，患有ADRD的NH居民的住院时间更长。执业护士（NPs）是美国ADRD患者NH护理的主要提供者，包括在5000个设施中提供护理的11,222名临床医生。一个日益增长的战略，以改善居民的结果是有效地将卫生信息技术（HIT）纳入国家卫生保健服务。将医疗信息技术应用于住院医师护理、临床支持和行政活动（称为医疗信息技术成熟），并将其整合，可加强住院医师和工作人员之间的护理协调和沟通，使住院医师能够更好地管理住院医师的健康状况，改善住院医师的治疗效果。有证据表明，NPs在更积极的护理环境中为居民提供更高质量的护理，具有支持性的大学关系，更容易获得资源和信息。关注NH住院患者ADRD护理的研究证实，技术、共享沟通、具有明确NP角色的护理环境、有益的关系和支持性护理可提高质量。我们将研究NH HIT成熟度和护理环境对患有ADRD的居民的结果的影响，包括住院和急诊就诊。我们的具体目标是：1)对NHs照顾ADRD居民的HIT成熟度和NP护理环境进行全面评估；2)检查NH HIT成熟度和NP护理环境对ADRD居民差异的影响；3)从NH管理者和NPs的角度探讨不同HIT成熟度和护理环境下ADRD居民改善结果的促进因素和障碍。在目标1中，我们将调查来自1400个NHs的管理人员和np，收集来自每个学科的HIT成熟度和护理环境数据。我们将把调查与国家国民健康保险数据联系起来。我们将通过NH特征评估HIT成熟度和NP护理环境的差异。还将测试HIT成熟度与护理环境之间的关联。在目标2中，我们将探讨护理环境对HIT成熟度和健康结果之间关系的潜在中介作用。我们将在进行调查的同一年将调查与居民水平数据（即医疗保险索赔）联系起来。在目标3中，我们将与代表不同HIT成熟度和护理环境的NH管理员（n = 70）和NPs （n = 70）进行关键信息提供者访谈。了解HIT的成熟度和管理人员和NPs工作的护理环境将有助于我们确定方法，以释放其最大潜力，提高患有ADRD的居民的NH护理质量。我们将确定管理人员和np工作的NHs中HIT成熟度和护理环境的差异，使我们能够确定可以实施的有针对性的干预措施，以改善患有ADRD的居民的结果。