Patient Safety Culture in Assisted Living: Association with Outcomes

项目摘要/摘要 美国的辅助生活(AL)社区主要是为了填补独立生活之间的差距而设计的 和养老院，提供住房和支助服务。生活在AL的人的敏锐度增加了 在过去的二十年里，今天超过50%的AL居民需要支持性护理，如帮助 在日常生活能力(ADL)方面，40%的人患有中度至重度痴呆症，90%的人患有中度至重度痴呆症 某种程度的认知障碍。AL社区的快速增长在很大程度上是在没有联邦政府的情况下发生的 融资或监督，以及不同的州监管努力和严格程度。因此，相对较少的是 了解AL环境的安全文化及其对居民安全和健康结果的影响。 1999年医学研究所(IOM)的报告《犯错是人》促使许多医疗保健组织 注重“患者安全文化”和组织护理流程的必要性，以最大限度地减少护理服务的提供 错误和改善病人护理的提供。在过去十年中，在改善安全文化方面取得了重大进展 (例如，团队合作、对患者安全的管理支持)在急诊护理医院，在某种程度上在护理方面 家庭，而且文献表明，改进的安全文化与更好的患者相关 结果。相比之下，受州监管的AL社区没有或很少受到联邦政府的审查 政策制定者，国家对这些组织的监管差异很大，对它们的安全性更是知之甚少 文化。在很大程度上，Al社区的报告要求比养老院要少得多 为有类似护理需求的居民提供服务。目前尚不清楚州AL法规的严格程度是否以及程度 影响护理环境中安全文化实践的发展，以及这两种力量如何影响 居民的结果。为了解决这些知识上的重大差距，我们提议的项目将审查 AL患者安全文化的差异及其与居民健康结局的关系，以及状态的潜在影响 关于安全文化和结果的规定。 我们建议在具有全国代表性的大样本中调查管理人员和直接护理人员 使用AHRQ患者安全调查工具的改编版本。我们将使用现有的数据库 国家ALR法规和政策。我们将使用联邦医疗保险管理和索赔数据来识别AL居民 并定义风险调整后的结果。我们还将使用公共使用数据来定义其他所需的协变量。 这些数据将用于构建AL患者安全文化措施、国家严格措施、措施 居民的风险调整结果，以及设施、市场和州的协变量。假设将使用以下工具进行测试 多变量回归。通过这项研究产生的信息将增加对AL社区的了解 以及他们充分和安全地为居民服务的能力。该项目将提供急需的证据 用于设计未来的实践和政策倡议，旨在提高AL患者的安全和护理质量。

Project Summary/Abstract Assisted living (AL) communities in the U.S. were largely designed to fill the gap between independent living and nursing home by providing housing and support services. The acuity of persons living in AL has increased over the last two decades, and today more than 50% of AL residents require supportive care such as help with medications and assistance in activities of daily living (ADLs), 40% have moderate to severe dementia, and 90% some degree of cognitive impairment. The rapid growth of AL communities has occurred largely without federal financing or oversight and with variable state regulatory efforts and stringency. Consequently, relatively little is known about the safety culture of the AL environment and its impact on residents' safety and health outcomes. The 1999 Institute of Medicine (IOM) report “To Err is Human” prompted many healthcare organizations to focus on “patient safety culture” and the need to organize their care processes so as to minimize care delivery errors and improve the provision of patient care. In the last decade, significant progress to improve safety culture (e.g. teamwork, management support for patient safety) in acute care hospitals, and to some extent in nursing homes, has been made and the literature shows that improved safety culture is associated with better patient outcomes. By comparison AL communities, which are state-regulated, receive no or little scrutiny from federal policy makers, the state oversight of these organizations vary widely, and even less is known about their safety culture. AL communities have substantially fewer reporting requirements than nursing homes yet to a large extent serve residents with similar care needs. It is not known if and to what extent the stringency of state AL regulations impacts the development of safety culture practices in this care setting, and how both of these forces influence residents' outcomes. To address these significant gaps in knowledge our proposed project will examine the variation in AL patient safety culture, its relationship to residents' health outcomes, and the potential impact of state regulations on safety culture and outcomes. We propose to survey administrators and direct care workers in a large, nationally representative sample of ALs using an adapted version of the AHRQ patient safety survey instrument. We will employ existing databases of state ALR regulations and policies. We will use Medicare administrative and claims data to identify AL residents and to define risk-adjusted outcomes. We will also employ public use data to define other needed covariates. These data will be used to construct AL patient safety culture measures, measures of state stringency, measures of residents' risk-adjusted outcomes, and facility, market and state covariates. Hypotheses will be tested using multivariable regressions. The information generated through this study will increase knowledge of AL communities and their ability to adequately and safely serve their residents. The project will provide the much-needed evidence for the design of future practice and policy initiatives aimed at improving patient safety and care quality in AL.