Understanding Processes of Care and Patient Safety Outcomes in Nursing Homes: An

描述(申请人提供)：居民的安全和居民护理是疗养院提供的护理质量不可或缺的一部分。研究表明，患者安全文化在疗养院中发展较差，患者安全文化得分往往比医院低得多。因此，养老院的居民可能面临受到伤害的风险。很少有研究检查疗养院的患者安全，尽管人们越来越认识到了解什么预示着更有利的患者安全水平的重要性。特别是，需要证据来确定疗养院患者安全文化在避免不良住院结果方面所起的作用。使用唐纳贝迪安的结构-过程-结果(SPO)模型的修订版，该模型还包括文化等组织属性，本研究考察了最高管理层对疗养院患者安全文化(结构属性)的评分与安全护理过程和住院结果的客观衡量之间的关系。为了完成这一二次数据分析，本项目将利用三个数据来源：1)医疗研究和质量疗养院机构2008年完成的关于患者安全文化的调查，该调查由疗养院管理者和护理总监从具有全国代表性的4000家美国疗养院样本中完成，2)来自2008年在线调查认证和报告数据库的数据，以及3)2008年最低数据集。居民的束缚使用和导尿术将被用作过程的衡量标准，压疮、跌倒和尿路感染将被用来衡量患者的安全结果。为了检验疗养院的患者安全文化是否与护理过程和患者安全结果相关，本研究将利用一种先进的统计学方法对多水平数据进行建模，即两级分层广义线性模型。最终目标是通过了解注重安全的文化、护理流程和患者安全结果之间的关系，找到提高卫生保健质量的方法。这些首批研究成果有望有助于疗养院患者安全文化的发展，并促进可通过护理过程和住院结果衡量的卫生保健的改善。 公共卫生相关性：患者安全是疗养院护理的一个关键方面，人们越来越认识到了解什么预示着更高水平的患者安全的重要性。特别是，需要证据来确定疗养院患者安全文化在避免不良住院结果方面所起的作用。因此，重要的是要了解患者安全文化、护理过程和患者安全结果之间的关系。

DESCRIPTION (provided by applicant): The safety of residents and resident care are integral to the quality of care provided in nursing homes. Studies have shown that patient safety culture, defined as the outcome of a concerted organizational effort to move towards safety, is poorly developed in nursing homes and patient safety culture scores tend to be considerably lower than those of hospitals. Therefore, residents of nursing homes may be at risk of harm. Few studies have examined patient safety in nursing homes despite the growing recognition of the importance in understanding what predicts more favorable levels of patient safety. In particular, evidence is needed to ascertain the role nursing home patient safety culture plays in avoiding adverse resident outcomes. Using the revised version of Donabedian's Structure-Process-Outcome (SPO) Model, which also includes organizational attributes such as culture, this study examines the relationships between top management's ratings of nursing home patient safety culture (a structural attribute), and objective measures of safe processes of care and resident outcomes. To complete this secondary data analysis, this project will utilize three data sources: 1) the Agency for Healthcare Research and Quality Nursing Home Survey on Patient Safety Culture completed in 2008 by nursing home administrators and directors of nursing from a nationally representative sample of 4000 U.S. nursing homes, 2) data from the 2008 Online Survey Certification and Reporting Database, and 3) the 2008 Minimum Data Set. Restraint use and catheterization of residents will be used as measures of processes, and pressure sores, falls, and urinary tract infections will be used to measure patient safety outcomes. To examine if the patient safety culture of nursing homes is related to processes of care and patient safety outcomes, this study will utilize an advanced statistical approach to model multilevel data, namely two-level hierarchical generalized linear models. The ultimate goal is to find ways to improve the quality of health care through an understanding of the relationship between a culture focused on safety, care processes, and patient safety outcomes. These first research findings hopefully should contribute to the development of a patient safety culture in nursing homes and promote improvements in health care that can be measured by processes of care and resident outcomes. PUBLIC HEALTH RELEVANCE: Patient safety is a critical aspect of nursing home care and there is a growing recognition of the importance in understanding what predicts higher levels of patient safety. In particular, evidence is needed to ascertain the role nursing home patient safety culture plays in avoiding adverse resident outcomes. Therefore, it is important to understand the relationship of patient safety culture, processes of care, and patient safety outcomes.