Improving Quality of Care for Nursing Home Residents with Dementia

描述（由申请人提供）：痴呆症是一个关键的卫生保健和卫生政策问题，随着人口老龄化，它将变得更加重要和昂贵。我们在这项研究中的总体目标是通过严格检查和改进一项主要政策倡议——公开报告质量信息——来提高痴呆症养老院居民的护理质量，这对痴呆症养老院居民的护理过程和结果有影响。养老院是照顾痴呆症患者的主要场所，但养老院部门几十年来一直受到质量问题的困扰。多年来，越来越严格的监管未能将质量提高到可接受的水平，医疗保险和医疗补助服务中心于2002年启动了养老院比较（NHC），这是一项公共报告倡议，根据护理的某些方面对美国所有获得医疗保险和医疗补助认证的养老院进行评级。新出现的证据表明，由于国家卫生保健中心的实施，报告的临床质量发生了适度但积极的变化，美国政府继续为此投入资源。然而，对失智症患者的照顾与对非失智症患者的照顾有本质的不同。如果报告卡不能反映对老年痴呆症患者最重要的质量方面，或者强调不适合他们的结果，他们可能无法从质量改进中受益，痴呆症护理的质量可能会下降。这取决于设施是通过只针对报告措施的集中努力，还是通过目前尚不清楚的广泛的结构改革，来追求质量改善，以回应公众报告。尽管养老院是老年痴呆症患者护理的主要提供者，但这一重大政策举措对老年痴呆症患者护理的影响尚未得到评估。在这个项目中，我们的第一个目标是通过痴呆症状态定量地检查NHC对居民水平结果的影响，考虑到每个报告的痴呆症居民措施的适当性或潜在的不适当性。我们还考虑了一些未报告的质量度量。我们的第二个目标是定性地检查，使用对管理人员和工作人员的半结构化访谈，养老院提供者如何考虑痴呆症患者的质量，养老院在回应公众报道时采取的策略，以及这些策略的含义-有意和无意-对痴呆症患者的护理。这些策略可能包括编码改变和避免高风险居民以及各种提高质量的方法。我们的最终目的是评估提高公共报告能力的几种可能性，以提高痴呆症患者的护理质量，包括对现有措施进行额外的风险调整，以及将适合痴呆症但目前未报告的措施纳入国家卫生健康委员会。

DESCRIPTION (provided by applicant): Dementia is a critical health care and health policy issue which promises to become even more important and costly as the population ages. Our overall goal in this study is to improve the quality of care for nursing home residents with dementia by critically examining and developing improvements to a major policy initiative -public reporting of quality information- in terms of the effects on processes and outcomes of care for nursing home residents with dementia. Nursing homes are a major site of care for persons with dementia, but the nursing home sector has been plagued with quality problems for several decades. After years of increasingly stringent regulation failed to raise quality to acceptable levels, the Centers for Medicare and Medicaid Services in 2002 launched Nursing Home Compare (NHC), a public reporting initiative that rates all Medicare- and Medicaid- certified nursing homes in the United States on selected aspects of care. Emerging evidence documents modest but positive changes in reported clinical quality as a result of NHC, and the US government continues to pour resources into this effort. However, care of demented residents is inherently different from care of non- demented residents. If report cards do not reflect aspects of quality most important to nursing home residents with dementia or emphasize outcomes that are not appropriate for them, they may not benefit from quality improvements and quality of dementia care may decline. This depends on whether facilities pursue quality improvement in response to public reporting through focused efforts directed only at the reported measures or through broad, structural changes, which is currently unknown. Despite the fact that nursing homes are a major provider of care to elderly individuals with dementia, the effects of this major policy initiative on care of persons with dementia have not been evaluated. Our first aim in this project is to examine quantitatively the effect of NHC on resident-level outcomes by dementia status, considering the appropriateness or potential inappropriateness of each reported measure for demented residents. We also consider several unreported measures of quality. Our second aim is to examine qualitatively, using semi-structured interviews with administrators and staff, how nursing home providers think of quality for their residents with dementia, the strategies that nursing homes pursue in response to public reporting, and the implications of these strategies- intended and unintended--for care of residents with dementia. These strategies may include coding changes and avoidance of high-risk residents as well as varied approaches to quality improvement. Our final aim is to evaluate several possibilities for improving the ability of public reporting to raise quality of care for residents with dementia, including additional risk-adjustment of existing measures and potential inclusion in NHC of dementia-appropriate but currently unreported measures. PUBLIC HEALTH RELEVANCE: Our overall goal in this study is to improve the quality of care for nursing home residents with dementia by critically examining and developing improvements to a major policy initiative -public reporting of quality information- in terms of the intended and unintended effects on quality of care for nursing home residents with dementia. Dementia is a critical health care and health policy issue which promises to become even more important and costly as the population ages.