Nursing Homes: Medical Staff Models and Care Correlates

描述(由申请人提供)：该提案是一项可行性研究，试点测试了一种量化疗养院医务人员组织(NHMSO)的方法及其对相关医疗保健结果的影响。目的一、构建一套可靠有效的养老院医务人员组织结构测量工具，并进行中试。NHMSO量表将使用焦点小组的意见和对美国医学主任(AMDA)研究网络专家的认知访谈来制定。这种定标的仪器将与来自AMDA的医疗主任随机抽样进行试验，他们代表独立的护理机构。将使用标准调查技术(Dilman)和10%的数据检查，以确保输入数据库的答复的准确性。将进行信度、探索性因素分析、收敛效度和区分效度检验。为了进一步改进和改进该仪器，医务主任和管理人员的自我报告将与来自试点设施的1/3子样本的外部观察数据进行比较；这将允许计算收敛的有效性和方法差异。目的II.使用从美国医学主任协会(AMDA)成员中抽取的独立机构的医务主任的扩大随机样本，启动NHMSO调查工具的可行性研究。调查的可行性和概括性将通过计算答复率以及交叉验证和分组分析来确定。瞄准伊利诺伊州实施一项试点研究，以检查与NHMSO模式相关的临床护理结果。调查结果将与现有的养老院数据(养老院比较和OSCAR)合并。多变量回归技术，调整混杂的设施特征，将检查假设的NHMSO与先前定义的护理质量指标的关联。这项研究的结果及其框架将指导未来的项目，以探索医疗结构、医疗实践模式和卫生保健结果之间的关系。

DESCRIPTION (provided by the applicant): The proposal is a feasibility study that pilot tests a methodology to quantify nursing home medical staff organization (NHMSO) and its impact on relevant health care outcomes. Aim I. Construct and pilot test a reliable and valid instrument to measure nursing home medical staff organizational (NHMSO) structure. The NHMSO scale will be developed using input from focus groups and cognitive interviews with experts from the American Medical Directors (AMDA) Research Network. The scaled instrument will be piloted with a random sample of medical directors from AMDA, who represent freestanding nursing facilities. Standard survey techniques will be used (Dilman) with a 10% data check to ensure accuracy of responses entered into the database. Reliability, exploratory factor analysis, and tests for convergent and discriminant validity will be conducted. To further refine and enhance the instrument, a Medical director and administrator self-report will be compared to external observational data on a 1/3 sub-sample of the facilities from the pilot; this will allow the calculation of convergent validity and method variance. Aim II. Initiate a feasibility study of the NHMSO survey instrument using an expanded random sample of medical directors from freestanding facilities drawn from the American Medical Directors Association (AMDA) membership. The feasibility and generalizability of the survey will be determined by calculating response rates as well as cross validation and sub-group analyses. Aim Ill. Implement a pilot study to examine clinical care outcomes associated with NHMSO patterns. The survey results will be merged to available nursing home data (Nursing Home Compare and OSCAR). Multivariate regression techniques, adjusting for confounding facility characteristics, will examine the hypothesized association of NHMSO with the previously defined quality of care metrics. Results of this study and its framework will guide future projects to explore the relationship between medical structure, medical practice patterns and health care outcomes.