Nursing Home Training to Impact CMS Indicators

描述（由申请人提供）：大量政府和非政府研究的结果支持了对老年痴呆症患者养老院护理质量的广泛关注和抱怨（引用自Harris & Clauser， 2002）。阿尔茨海默病协会（2003）报告说，在养老院和辅助生活中心患有阿尔茨海默病（AD）和相关痴呆症的人需要比现在得到更好质量的护理。提供直接、长期护理的美国工人的流动也会影响护理质量，每位员工的成本估计约为3500美元，每年超过40亿美元（Seavey, 2004）。因此，第二阶段的长期目标是完成一系列通常是互动的在线培训和干预模块，使用申请人注册的全面护理方案，这是一个循序渐进的过程，旨在提高住院痴呆症护理的质量。第一阶段的成就为拟议的三年期第二阶段奠定了基础。第二阶段的目标是完成第一阶段训练原型的四个模块的开发；制作和测试六个新的培训模块；对所有十个培训模块进行全国试点研究，以期开展后续研究，调查CARES培训干预措施对CMS质量护理指标的影响；并分析和报告在试点研究中收集的关于知识获取、护理行为和员工离职率的数据。通过前后测试，项目申请者假设CNA知识显著增加。评估设计还可以进行探索性研究，以检查痴呆症居民CNA临床行为变化的程度和性质，实施CARES对机构CMS质量护理指标得分的影响，以及通过个体机构分析测量的参与试点研究的CNA的员工流失率的影响。该项目与国家老龄研究所的使命以及总体上的公共卫生高度相关，因为它对护理助理的培训和医疗保险服务中心（CMS）质量护理指标衡量的质量护理的改善具有深远的影响。此外，通过培训cna采用适合任何护理情况的干预方法，实施CARES协议可以显著改善对痴呆症或AD患者的护理。

DESCRIPTION (provided by applicant): Widespread concerns and complaints about the quality of nursing home care for persons with dementia are supported by findings from numerous government and non-government studies (as cited in Harris & Clauser, 2002). The Alzheimer's Association (2003) reports people with Alzheimer's disease (AD) and related dementias in nursing homes and assisted living centers require better quality care than they now receive. Quality care is also affected by turnover in U.S. workers providing direct, long-term care, for which cost estimates equal approximately $3,500 per employee-more than $4 billion a year (Seavey, 2004). The long- term goal of this Phase II is therefore to complete a series often interactive, online training and intervention modules utilizing the applicants' trademarked total-approach CARES-protocol, a step-by-step process designed to improve the quality of residential dementia care. Phase I accomplishments provide the foundation for the proposed three-year Phase II. Phase II aims are to complete the development of the four- module Phase I training prototype; produce and test six new training modules; conduct a nationwide pilot study of all ten training modules in anticipation of a follow-on study to investigate the effects of CARES training interventions on CMS quality care indicators; and analyze and report the data collected in the pilot study about knowledge gain, caregiving behavior, and staff turnover rates pre/post training. Project applicants hypothesize a significant increase in CNA knowledge as measured by pre- and post-tests. The evaluation design also enables exploratory research to examine the extent and nature of changes in CNA clinical behavior with dementia residents, the impact of CARES implementation on facilities' CMS quality care indicator scores, and the effect on rates of staff turnover among CNAs involved in the pilot study as measured by individual facility analysis. The project is highly relevant to the mission of the National Institute on Aging as well as to public health in general, because it has far-reaching implications for the training of nursing assistants and improvement of quality care as measured by the Centers for Medicare Services (CMS) quality care indicators. Additionally, implementation of the CARES protocol could significantly improve care for residents with dementia or AD by training CNAs in an intervention approach appropriate for any caregiving situation.