Evidence-Based Medicine in the Skilled Nursing Facility

描述（由申请人提供）：Colon-Emeric博士的目标是成为一名学术老年病专家，并在提高养老院护理质量方面成为全国公认的领导者。她为实现这一目标的初步工作包括完成临床研究健康科学硕士学位，以及作为布鲁克代尔国家老年病学研究员在养老院进行跌倒和骨折预防的研究项目。有了这个Paul a . Beeson奖，她计划从一个半独立的调查员发展成为一个独立的调查员，因为她在定性方法和卫生服务研究方面获得了额外的教学培训和研究经验。她的研究项目将由这些领域的专家指导，包括Kenneth Schmader博士、Morris Weinberger博士和Ruth Anderson博士。杜克大学老年中心的丰富资源将被用于支持Colon-Emeric博士的发展。她的研究项目包括两个具有两个具体目标的互补项目：1)确定管理实践，系统特征和提供者信念，增强或阻碍在养老院使用循证最佳实践；2)开发和试点测试信息技术系统干预措施，以促进养老院的循证最佳实践。为了实现第一个目标，她将与研究人员合作，利用定性和定量方法，对国家自然研究所资助的高质量和低质量护理设施进行案例研究。将在2个高质量和2个低质量设施中与护理助理、持证护理人员、医务人员和管理人员进行半结构化访谈和焦点小组。访谈调查将被构建来阐明障碍和促进在护理机构骨质疏松症，跌倒和发烧评估的循证护理。将使用来自较大个案研究的数量数据，包括设施质量指标、居民生活质量数据、网络分析和信息流措施。分析将描述在寻求改进循证实践的项目中应该模仿或不鼓励的系统和实践。在这些结果的基础上，Colon-Emeric博士将开发并试点测试一个信息技术系统，该系统提供评估和治疗方案、决策辅助和多学科教育工具，鼓励在现有的计算机订单输入系统中进行循证实践。常见的老年综合症（尿路感染、发烧、骨质疏松、跌倒和肺炎）将成为目标，并将使用学术和社区退伍军人管理局养老院护理单位。

DESCRIPTION (provided by applicant): Dr. Colon-Emeric aims to become an academic geriatrician and a nationally-recognized leader in improving the quality of care in nursing homes. Her initial work toward this goal has included the completion of a Masters of Health Science in Clinical Research, and research projects on fall and fracture prevention in nursing homes as a Brookdale National Geriatrics Fellow. With this Paul A. Beeson award she plans to progress from a semi-independent to an independent investigator as she acquires additional didactic training and research experience in both qualitative methodology and health services research. Her research program will be overseen by mentors with expertise in these areas including Dr. Kenneth Schmader, Dr. Morris Weinberger, and Dr. Ruth Anderson. The rich resources of the Duke University Center for Aging will be utilized in support of Dr. Colon-Emeric's development. Her research program includes two complementary projects with two specific aims: 1) Identify management practices, system characteristics, and provider beliefs that enhance or impede the use of evidence-based best practice in nursing homes; and 2) Develop and pilot test information technology systems interventions which promote evidence-based best practice in nursing homes. To achieve the first aim she will work with investigators on a NINR-funded case-study of high and low quality nursing facilities, utilizing both qualitative and quantitative methodology. Semi-structured interviews and focus groups will be conducted with nursing assistants, licensed nursing staff, medical staff, and administrators in 2 high-quality and 2 low-quality facilities. Interview probes will be constructed to elucidate the barriers and facilitators to evidence-based care for osteoporosis, falls, and fever evaluation in nursing facilities. Quantitative data from the larger case-study including facility quality indicators, resident-level quality of life data, network analyses and measures of information flow will be used. Analyses will describe systems and practices that should be emulated or discouraged in programs seeking to improve evidence-based practice. Building on these results, Dr. Colon-Emeric will then develop and pilot test an information technology system that provides evaluation and treatment options, decision-aids, and multidisciplinary educational tools encouraging evidence-based practice within an existing computerized order entry system. Common geriatric syndromes conditions (UTI, fever, osteoporosis, falls, and pneumonia) will be targeted, and both an academic and a community-based Veterans Administration Nursing Home Care Unit will be used.