Evaluating Quality of Long Term Care

描述(由申请人提供)：该职业发展奖的目的是支持辛蒙德博士在提高老年护理质量方面建立职业生涯。津蒙德博士的总体目标是研究接受机构和居家长期护理的老年人的医疗和护理流程，以及这些护理流程如何与主要和次要的结果衡量标准相关联。这种以过程为导向的方法扩展了先前在长期护理质量方面的工作，这些工作主要侧重于基于结果的绩效衡量。然而，结果并不能确定要做什么，没有不良事件并不一定意味着良好的护理。 对长期护理质量的评估仍处于初级阶段，部分原因是老年人的一般健康状况较差 这些患者、护理目标和结果的复杂性，以及缺乏常规收集的患者健康、接受的护理或与长期护理相关的结果的衡量标准。重要的是要了解(1)患者和提供者的特征如何影响患者护理，(2)护理过程如何衡量并与患者结果相关，以及(3)从家庭护理到疗养院护理，哪些过程在减少长期护理的不良结果方面是有效的。 这项拟议的研究有三个目标，将成为津蒙德博士未来工作的基础。 总而言之，这个辅导式职业发展奖的具体目的是： 1.使接受(A)居家或(B)机构长期护理的个人护理过程的共识专家质量指标适应行政数据；并确定加州向患者提供的长期护理的质量。 2.研究护理程序对养老院接受者维持功能、防止过度使用和降低死亡率的影响。 3.研究护理过程对维持家庭护理接受者的独立性和功能、防止过度使用和降低死亡率的影响。

DESCRIPTION (provided by applicant): The purpose of this career development award is to support Dr. Zingmond in establishing a career in improving the quality of geriatric care. Dr. Zingmond's overall goal is to examine the medical and nursing processes of care among older individuals receiving institutional and home-based long-term care and in turn, how these processes of care can be related to primary and secondary measures of outcome. This process-oriented approach extends prior work in quality of long-term care that has focused primarily on outcomes-based performance measures. Yet, outcomes do not pinpoint what to do and a lack of adverse events does not necessarily indicate good care. Evaluation of long-term care quality is still in its infancy in part due to the poorer general health of these patients, the complex nature of the goals and outcomes of care, and the lack of routinely collected measures of patient health, care received, or outcomes relevant to long-term care. It is important to understand (1) how patient and provider characteristics affect patient care, (2) how care processes can be measured and related with patient outcomes, and (3) which processes are effective in reducing undesired outcomes across the spectrum of long-term care, from home-based care to nursing home care. The proposed research has 3 aims that will form the basis for Dr. Zingmond's future work. In summary, the specific aims of this mentored career development award are to: 1. Adapt consensus expert quality indicators of processes of care for individuals receiving (a) homebased or (b) institutional long-term care to administrative data; And Characterize the quality of long-term care delivered to patients in California. 2. Examine the impact of process of care on maintaining function, preventing over-utilization, and decreasing mortality among nursing home recipients. 3. Examine the impact of process of care on maintaining independence and function, preventing over-utilization, and decreasing mortality among home care recipients.