PRESSURE ULCER RATES IN DESCRIBING NURSING HOME QUALITY

风险调整后的结果指标已被广泛提倡用于 疗养院护理 这些信息可用于质量改进 努力，作为报销的依据，并帮助引导消费者 在选择养老院的时候压力性溃疡的发展是一个 护理之家护理的重要不良后果。 重要预测因素 压力性溃疡的发展现在可以从数据库中获得， 最低限度数据集，这是一个综合评估工具， 所有接受联邦资助的疗养院 我们建议发展一个 基于最小数据集的风险调整模型 该模型用于评估病例组合调整后的压疮发生率 在个别养老院的发展。 我们将使用由国家医疗保健中心维护的现有数据库 (NHC)一家私人连锁养老院。 这个数据库包含信息 季度最小数据集评估。压疮发生率 发展将通过计算居民的比例来确定， 没有溃疡的初步评估谁有压力溃疡， 随后的评估。 压疮发展的预测因素将 从描述的患者特征中识别， 最小数据集。 模型性能将在单独的 验证样品。 观察到的和预期的压疮发生率 个别护养院的发展将会计算在内。 我们将 将这些结果与基于其他风险调整的评估进行比较 模型 我们还将应用贝叶斯分层建模， 评估设施性能的问题。 本研究结果 可以成为改善养老院的重要管理工具 在乎

Risk-adjusted outcome measures have been widely advocated for use in nursing home care. Such information may be used in quality improvement efforts, serve as the basis for reimbursements, and help guide consumers in their selection of a nursing home. Pressure ulcer development is an important adverse outcome of nursing home care. Important predictors of pressure ulcer development may now be obtained from databases based on the Minimum Data Set, a comprehensive assessment instrument used in all nursing homes receiving federal funding. We propose to develop a risk-adjustment model that is based on the Minimum Data Set and apply this model to evaluate case-mix adjusted rates of pressure ulcer development at individual nursing homes. We will use an existing database maintained by the National Healthcare (NHC), a private nursing home chain. This database contains information from quarterly Minimum Data Set assessments. Rates of pressure ulcer development will be determined by calculating the fraction of residents without an ulcer on an initial assessment who have a pressure ulcer on a subsequent assessment. Predictors of pressure ulcer development will be identified from among patient characteristics described in the Minimum Data Set. Model performance will be evaluated in a separate validation sample. Observed and expected rates of pressure ulcer development will be calculated for individual nursing homes. We will compare these results to assessments based on other risk adjustment models. We will also apply Bayesian Hierarchical Modeling to the problem of evaluating facility performance. Results from this study could lead to an important management tool for improving nursing home care.