Older adult safety while receiving home health services after hospital discharge

描述(由申请人提供)：老年人在护理过渡期间的错误是常见的，代价高昂，有时甚至是致命的。护理过渡的定义是一个人从一个医疗保健环境转移到另一个医疗保健环境，通常与不良后果有关。人口老龄化正在导致对家庭护理的更大依赖，家庭护理是最常见且鲜为人知的医疗保健提供环境。由于不明原因，那些在出院后需要熟练的家庭保健(SHHC)服务(例如，家庭护理)的人是经历再次住院的最高风险的人之一。针对医院/SHHC过渡的复杂性而量身定做的战略需要确保安全过渡，但指导改进工作的研究相对较少。这项拟议研究的总体目标是开发一个指数，供SHHC机构实时使用，以识别和减少医院/SHHC过渡期间对老年人安全的潜在风险。具体目标1：识别与以下相关的老年人安全的潜在风险：(1)跨环境的SHHC提供者之间的信息管理，以及(2)为执行医疗保健任务建立老年人、照顾者和SHHC提供者的角色。我们将使用前瞻性风险识别方法来识别潜在风险：(A)直接观察老年人的医院/SHHC过渡；以及(B)对老年人/照顾者/SHHC提供者进行半结构化访谈。具体目标2：开发一个指数，供SHHC机构实时使用，以识别在医院/SHHC过渡过程中有关信息管理和角色建立的老年人安全风险。通过焦点小组，SHHC提供者将根据SA1中确定的每个风险对确保安全的重要性及其发生频率进行评级。具体目的3：评价该指数的心理测量学特性，确定其使用的可行性。3A.评估SHHC提供者之间的指标评定者间信度，并在不同质量的护理过渡之间建立初始结构效度。对于评价者间的可靠性，我们将确定由评估一系列护理过渡的SHHC提供者对计算的指数得分之间的相关性。对于结构效度，我们将比较护理过渡质量不同的病例的指数得分。3B.为了进一步评估结构的有效性，使用不同的标准，并确定在SHHC提供者中使用的可行性。在出院后接受SHHC的老年人的预期样本中，我们将确定SHHC提供者生成的指数评分与患者报告的护理过渡质量的一般衡量标准(护理过渡衡量，或CTM-3)之间的相关性。拟议的研究将填补在理解老年人护理过渡方面的关键空白，这些老年人特别容易受到安全问题的影响。研究结果有可能适用于更广泛的群体 从医院过渡到家庭并需要复杂护理的患者。

DESCRIPTION (provided by applicant): Errors during care transitions of older adults are common, costly, and sometimes lethal. A care transition is defined as the movement of a person from one healthcare setting to another and is commonly associated with adverse outcomes. The aging of the population is leading to greater reliance on care delivered in the home, the most common and poorly understood healthcare delivery setting. For unclear reasons, those who require skilled home healthcare (SHHC) services (e.g., home nursing) after hospital discharge are among those at highest risk of experiencing hospital readmission. Strategies tailored to the complexity of the hospital/SHHC transition are needed to ensure safe transitions, yet there is relatively little research to guide improvement efforts. The overall goal of the proposed study is to develop an index to be used by SHHC agencies in real time to identify and reduce potential risks to older adults' safety during hospital/SHHC transitions. SPECIFIC AIM 1: To identify potential risks to older adults' safety related to (1) information management among SHHC providers across settings, and (2) establishment of older adult, caregiver, and SHHC provider roles for execution of healthcare tasks. We will use prospective risk identification methods to identify potential risks: (a) direct observations of older adults' hospital/SHHC transition; and (b semi-structured interviews of older adults/caregivers/SHHC providers. SPECIFIC AIM 2: To develop an index that will be used by SHHC agencies in real time to identify risks to older adults' safety during hospital/SHHC transitions with regard to processes of information management and establishment of roles. Through focus groups, SHHC providers will rate each risk identified in SA1 on its importance to ensuring safety and its frequency of occurrence. SPECIFIC AIM 3: To evaluate psychometric properties of the index and ascertain feasibility of use. 3a. To evaluate index inter-rater reliability among SHHC providers and establish initial construct validity among care transitions that differ in quality. For inter-rater reliability, we wll determine the correlation between index scores calculated by pairs of SHHC providers evaluating a series of care transitions. For construct validity, we will compare index scores among cases that differ in care transition quality. 3b. To further evaluate construct validity usin a different standard and ascertain feasibility of use among SHHC providers. In a prospective sample of older adults receiving SHHC after hospital discharge, we will determine the correlation between SHHC provider-generated index scores and a general measure of patient-reported care transition quality (Care Transitions Measure, or CTM-3). The proposed study will fill critical gaps in the understanding of care transitions of older adults who are particularly vulnerable to safety issues. Study findings have the potential for applicability to a broader group of patients who transition from hospital to home and require complex care.