Older adult safety while receiving home health services after hospital discharge

描述（由申请人提供）：老年人护理过渡过程中的错误很常见，成本高昂，有时甚至是致命的。护理过渡被定义为一个人从一种医疗保健环境转移到另一种医疗保健环境，通常会带来不良后果。人口老龄化导致人们更加依赖家庭护理，这是最常见且了解甚少的医疗服务环境。由于不明原因，出院后需要熟练家庭医疗保健 (SHHC) 服务（例如家庭护理）的人是再次入院风险最高的人。需要针对医院/SHHC 过渡的复杂性制定策略来确保安全过渡，但指导改进工作的研究相对较少。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 过渡期间老年人安全的潜在风险。具体目标 1：确定与以下方面相关的老年人安全潜在风险：(1) 跨环境的 SHHC 提供者之间的信息管理，以及 (2) 建立老年人、护理人员和 SHHC 提供者执行医疗保健任务的角色。我们将使用前瞻性风险识别方法来识别潜在风险： (a) 直接观察老年人医院/SHHC 的转变； (b 对老年人/护理人员/SHHC 提供者进行半结构化访谈。具体目标 2：制定一个指数，SHHC 机构将使用该指数实时识别医院/SHHC 过渡期间在信息管理和角色建立过程中对老年人安全造成的风险。通过焦点小组，SHHC 提供者将评估 SA1 中确定的每个风险对确保安全的重要性及其发生频率。具体目标 3：评估该指数和3a. 为了评估 SHHC 提供者之间的指标间可靠性并建立不同质量的护理转换之间的初始构建有效性，我们将确定评估一系列护理转换的成对的指数得分之间的相关性，我们将使用不同的标准来进一步评估构建有效性，并确定在老年医疗保健提供者中使用的可行性。对于出院后接受 SHHC 的成年人，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（护理过渡衡量标准，或 CTM-3）之间的相关性。这项研究将填补对特别容易受到安全问题影响的老年人护理过渡的理解的关键空白。研究结果有可能适用于更广泛的群体。 从医院转移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.