NURSING CARE PROCESSES, OUTCOMES & COST IN NURSING HOMES

描述(改编自《调查员摘要》)：本申请 建议描述密苏里州疗养院的护理提供过程，并 这些护理提供过程、护理成本和 将人员配置与驻地工作人员的成果挂钩。使用中开发的发现和方法 初步研究，三组探索性描述性研究设计将 用来定性地描述护理提供的过程 具有良好的常驻结果的设施，以描述这些过程如何 不同的设施具有一般或较差的居民结果，以及 描述与Good相关的范例护理交付流程 居民结果。此外，护理成本、人员配备水平和 居民结果好、一般和差的家庭的工作人员组合将是 定量描述。医疗费用、人员配备水平、 还将介绍工作人员混合到护理的交付过程。居民 结果将从驻地评估的最低数据集和 护理筛查(MDS)数据。医疗补助费用报告数据将用于 评估护理、人员配备和人员组合的成本(RN、LPN、NA)。这个 申请的第一笔奖励资金将使主要PI能够在 进行大量的前期工作，并与 支持已经运作的跨学科研究团队。 了解护理服务提供过程、住院医生和住院医生之间的关系 结果、护理成本和人员配置是设计 可在养老院实施的组织干预措施 提高护理质量，进而改善住院结果。这 这项研究直接涉及国际移民组织委员会关于 医院及疗养院护士人手是否足够(1996) 人员配备水平、技能组合和护理质量之间的关系 养老院可以进一步探索。随着人们对人际关系的更好理解， 养老院提供者可以调整其工作人员组合和护理流程，以 提高提供的服务质量。消费者及其家人可以 更多地了解示范护理提供过程的重要性 和人员配备。

DESCRIPTION (Adapted from the Investigator's Abstract): This application proposes to describe care delivery processes in Missouri nursing homes and the relationship of those care delivery processes, costs of care, and staffing to resident outcomes. Using findings and methods developed in preliminary studies, a three group exploratory descriptive study design will be used to qualitatively describe the processes of care delivery in facilities that have good resident outcomes, to describe how these processes differ in facilities that have average or poor resident outcomes, and to describe exemplar care delivery processes that are associated with good resident outcomes. Additionally, the costs of care, staffing levels, and staff mix in homes with good, average, and poor resident outcomes will be described quantitatively. The relationship of cost of care, staffing level, and staff mix to care delivery processes also will be described. Resident outcomes will be derived from Minimum Data Set for Resident Assessment and Care Screening (MDS) data. Medicaid cost report data will be used to evaluate costs of care, staffing, and staff mix (RN, LPN, NA). The requested FIRST award funding will enable the principal PI to build on substantial preliminary work and undertake this proposed study with the support of an already functioning interdisciplinary research team. Understanding the relationships among processes of care delivery, resident outcomes, costs of care, and staffing is essential to designing organizational interventions that can be implemented in nursing homes to improve quality of care and subsequently improve resident outcomes. This study directly addresses research recommendations from the IOM Committee on the Adequacy of Nurse Staffing in Hospitals and Nursing Homes (1996) that the relationships of staffing levels, skill mix, and quality of care in nursing homes be further explored. With relationships better understood, nursing home providers can adjust their staff-mix and care processes to improve the quality of services delivered. Consumers and their families can be more informed about the importance of exemplar care delivery processes and staffing.