Post-Hospital Discharge Adverse Events in the Nursing Home Setting

 描述(申请人提供)：拟议的研究落在长期护理、养老院居民安全的流行病学和可能导致养老院环境中减少危害的质量改进活动的交叉点上。具体地说，我们将研究长期护理居民从疗养院环境过渡到急性护理环境，然后再出院到相同设施中发生的不良事件。在本研究中，不良事件被定义为由于医疗护理而对疗养院居民造成的伤害或伤害，包括未能提供必要的护理。的设置 这项工作将是来自新英格兰六个州的30家养老院的代表性样本。这项研究将与新英格兰质量创新网络-质量改进组织(NE QIN-QIO)合作进行。我们将利用一种实用的方法(触发工具方法学)可靠地识别、量化和描述不良事件。触发工具方法论是由医疗保健改进研究所开发的，使用“触发”或线索来识别医疗记录中最终可能与伤害有关的不良事件。该方法已被改编用于广泛的临床环境中。本研究的具体目的包括：(1) 确定长期住院并返回相同设施的疗养院居民在出院后45天期间发生的不良事件的发生率、类型、严重性和可预见性；(2)确定与住院并返回相同设施的疗养院居民在45天期间发生的不良事件相关的人口统计学、临床和功能性居民特征；(3)确定与住院并返回同一设施的疗养院居民在出院后45天内发生不良事件相关的设施水平特征；以及(4)检查新英格兰地区国家疗养院质量护理合作组织的设施参与程度对住院并返回同一设施的疗养院居民不良事件发生的影响。这项研究侧重于一种护理环境，其特点是质量和人员配备可变，医生参与有限，对患者安全和护理质量问题的关注不一致，而且往往不充分。我们努力的长期战略取决于这样一种期望，即通过确定疗养院居民在非常高风险的出院后期间与疗养院不良事件相关的安全担忧，可以开发出干预措施，以成功地对抗导致这一高度脆弱人群的次优护理和结果的系统。

 DESCRIPTION (provided by applicant): The proposed study falls at the intersection of long-term care, the epidemiology of nursing home resident safety, and quality improvement activities that may lead to the reduction of harm in the nursing home setting. Specifically, we will study adverse events that occur among long-term care residents who transition from the nursing home setting to an acute care setting, and then who are discharged back to the same facility. For the purpose of this study, an adverse event is defined as harm or injury to a nursing home resident as a result of medical care, including the failure to provide needed care. The setting for this work will be a representative sample of 30 nursing homes drawn from across the six New England states. The study will be conducted in collaboration with the New England Quality Innovation Network - Quality Improvement Organization (NE QIN- QIO). We will take advantage of a practical method (the trigger tool methodology) to reliably identify, quantify, and characterize adverse events. The trigger tool methodology was developed by the Institute for Healthcare Improvement and employs "triggers", or clues, to identify adverse events in medical records that can be ultimately linked to harm. The methodology has been adapted for use across a wide range of clinical settings. The specific aims of our study include the following: (1) to characterize the rates, types, severity, and preventability of adverse events that occur in the 45-day period post-hospital discharge among long-stay nursing home residents (long-stay = >100 days) who are hospitalized and return to the same facility; (2) to identify demographic, clinical, and functional resident characteristics associated with the occurrence of adverse events that occur in the 45-day period post-hospital discharge among nursing home residents who are hospitalized and return to the same facility; (3) to identify facility-level characteristics associted with the occurrence of adverse events that occur in the 45-day period post-hospital discharge among nursing home residents who are hospitalized and return to the same facility; and (4) to examine the impact of level of facility participation in the New England regional National Nursing Home Quality Care Collaborative on the occurrence of adverse events among nursing home residents who are hospitalized and return to the same facility. This study focuses on a setting of care characterized by variable quality and staffing, limited physician involvement, and inconsistent and often inadequate attention to patient safety and quality of care issues. The long range strategy underlying our efforts hinges on the expectation that by identifying safety concerns relevant to adverse events in nursing homes among residents during the very high-risk post-hospital discharge period, interventions may be developed to successfully combat systems that result in suboptimal care and outcomes in this highly vulnerable population.