Working Conditions & Adverse Events in Home Health Care

描述（应用摘要）：本项目将研究 组织的关键特征之间存在的关系 工作场所、劳动力和由于可预防的错误导致的不良患者事件 在家庭医疗环境中。 利用自然的变化， 在一个非常大的家庭健康机构的83个团队的工作条件， 项目将估计团队文化和人员配置变化的影响， 以及个别护士的特点和生产力，对不利 患者事件。 它还将研究病人护理与 错误和选定的不良事件。 工作环境措施和 劳动力特征将包括客观和主观的衡量标准 并将从常规管理和临床 数据，加上项目特定的主要数据，包括一线调查 护士和管理人员。 患者不良事件的指标将来自 卫生保健融资管理局制定的一套13项措施， 家庭保健，辅以少量其他措施 由专家小组选出。 该项目将采用定性 方法（访谈、专家小组、焦点小组）， 模型和假设，以及审查和解释的结果， 定量分析 它将采用计量经济学技术，包括 使用工具变量对事件和患者水平结局数据进行建模 （不良事件）在团队和护士水平。 它还将涉及记录 审查和统计分析，以评估关系的强度 病人护理失误和三种不良事件之间的关系。 项目 将是为数不多的理论驱动的实证，定量研究家庭 保健质量。 它应该导致更健全的干预研究， 有助于更广泛的文献工作条件，服务质量， 和患者安全。

DESCRIPTION (APPLICATION ABSTRACT): This project will examine the relationships that exist between and among key features of the organizational workplace, the workforce, and adverse patient events due to preventable errors in the home health care setting. Taking advantage of the natural variation in working conditions across 83 teams in a very large home health agency, the project will estimate the effects of variations in team culture and staffing, as well as individual nurse characteristics and productivity, on adverse patient events. It also will examine the relationship between patient care errors and selected adverse events. Measures of work environment and workforce characteristics will include both objective and subjective measures and will be obtained from a combination of routine administrative and clinical data, plus project-specific primary data, including a survey of frontline nurses and managers. Measures of adverse patient events will be drawn from a set of 13 measures developed by the Health Care Financing Administration for home health care, supplemented by a small number of additional measures selected with input from an expert panel. The project will employ qualitative methods (interviews, expert panel, focus groups) to elaborate the conceptual model and hypotheses, as well as to review and interpret the findings of the quantitative analyses. It will employ econometric techniques, including the use of instrumental variables, to model episode and patient level outcome data (adverse events) at the team and nurse level. It also will involve record review and statistical analysis to assess the strength of the relationship between patient care errors and three types of adverse events. The project will be one of the few theory-driven empirical, quantitative studies of home health care quality. It should lead to sounder intervention research and contribute to the broader literature on working conditions, service quality, and patient safety.