QUALITY OUTCOMES IN SUBACUTE AND HOME CARE PROGRAMS

该项目将开发两年内评估护理质量的方法

The project will develop methods for evaluating quality of care within two critical transitional settings following acute hospitalization; subacute nursing home programs and home care programs. This is a three-phase study effort, involving the use of two types of primary data and the extensive use of a large, multi-state secondary data base. The first set of primary data will be used to validate eight outcome measures (ADLs, mobility, cognition, communication, bowel, bladder, pain, and mood) based on comparative, tests with independently gathered sets of parallel measures. This aspect of primary data gathering program will be completed in nursing units and home care settings owned by HRCA or with whom HRCA maintains an ongoing research laboratory relationship. There will be 200 cases for each of the parallel form analyses. The second set of primary data will be gathered as part of a real-world feasibility trial of model. Patient-based assessments would be completed in all study years, with program sites' personnel scoring the outcome measures and covariates. The focus will be on patients newly admitted to these programs, with assessments at baseline, 90 days, and at discharge. These data will be gathered for patients served by the Prism Health Group -- 750 subacute and 450 home care patients. Prism will provide field sites it both its skilled nursing facilities and home health programs in Massachusetts for testing and validation of the outcome measures for patients from a broad range of diagnostic categories typically served in post-acute care.. For this project, Prism has agreed to institute MDS-HC data collection in its home health programs. Secondary data will be drawn from secondary sources to support covariate model development and to establish benchmark longitudinal change parameters. Using these data, we will complete the major analytic activities of this study, taking advantage of the high quality, computerized assessment data derived from programs in multiple states. HRCA's home-care data set currently encompasses approximately 3,000 patients. HRCAs subacute nursing home multi-state data set is a large and broad database of Minimum Data Set (MDS) assessments contained within tahe UMAAP archive. The database holds MDS assessment data representing 12 states' nursing home population. As of 1995, UMAAP contained over 2.7 million records describing approximately 1.5 million individual resident. Structural and administrative indicators and process-services measures will be entered. Models to predict change in status over various intervals will be created; where status change is defined in both dichotomous and continuous terms.