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.

我们的研究探讨了疗养院领导力、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) 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病的居民相比，患有 ADRD 的新罕布什尔州居民住院频率更高且住院时间更长。在美国，执业护士 (NP) 是为 ADRD 居民提供 NH 护理的主要提供者，包括在 5000 个机构提供护理的 11,222 名临床医生。改善居民治疗效果的一项不断发展的战略是将健康信息技术 (HIT) 有效地整合到 NH 护理服务中。 HIT 的使用和整合到住院医师护理、临床支持和行政活动中（称为 HIT 成熟度）可以增强 NP 和工作人员之间的护理协调和沟通，使 NP 能够更好地管理住院医师的健康状况并改善住院医师的治疗效果。有证据表明，NP 可以在更积极的护理环境中为居民提供更高质量的护理，并具有支持性的同事关系、更容易获得资源和信息。针对患有 ADRD 的新罕布什尔州居民的护理研究证实，技术、共享沟通和具有明确定义的 NP 角色、有益的关系和支持性护理的护理环境可以提高质量。我们将研究 NH HIT 成熟度和护理环境对 ADRD 居民结局的影响，包括住院和急诊就诊。我们的具体目标是：1) 对护理 ADRD 居民的 NH 中的 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 居民之间差异的影响，以及 3) 从 NH 管理者和护理人员的角度，探索通过不同的 HIT 成熟度和护理环境实现 ADRD 居民改善结果的促进因素和障碍。 NP。在目标 1 期间，我们将对 1400 个 NH 的管理人员和 NP 进行调查，收集每个学科的 HIT 成熟度和护理环境数据。我们将把调查与国家 NH 数据联系起来。我们将根据 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受到测试。在目标 2 中，我们将探讨护理环境对 HIT 成熟度与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年期间将调查和居民级别数据（即医疗保险索赔）联系起来。在目标 3 期间，我们将对代表不同 HIT 成熟度和护理环境的 NH 管理员 (n = 70) 和 NP (n = 70) 进行关键知情人访谈。了解 HIT 的成熟度以及管理人员和 NP 工作的护理环境将有助于我们找到方法，以释放其最大潜力，从而提高 ADRD 居民的 NH 护理质量。我们将确定管理人员和 NP 工作的 NH 中 HIT 成熟度和护理环境的差异，从而使我们能够确定可实施的有针对性的干预措施，以改善 ADRD 居民的治疗结果。