Care coordination for older adults: Process, outcomes, cost

描述（由申请人提供）：最近的研究提供证据表明，护理协调可以改善住院、再住院、急诊室使用等结果，并降低成本。密苏里大学辛克莱护理学院（University of Missouri's Sinclair School of Nursing）的一个项目是将护士护理协调作为一种干预手段来改善社区老年人的护理。AIP加强护士护理协调干预的服务提供者是高级护理，一个家庭健康机构和家庭和社区服务提供者。AIP研究结束后，高级护理继续作为家庭保健（HHC）机构存在。利用AIP研究和HHC机构的独特数据，我们建议进行二次分析，以(1)确定AIP护士护理协调员使用的护理协调干预措施、干预活动和干预剂量，以及HHC护士提供的传统HHC，(2)描述AIP护士护理协调员和HHC护士使用的干预措施的差异，最后(3)确定住院结果，AIP组和HHC组的老年人再住院、急诊室使用和费用不同。最初的AIP分析没有将特定的护理协调干预与结果联系起来，没有确定与干预相关的具体活动，没有探索干预剂量，也没有将结果与传统的HHC进行比较。数据将比较两组接受服务的老年人，一组是2000-2002年在AIP组中加强了护理协调的老年人，另一组是2003-2005年在没有加强护理协调的情况下接受传统HHC的老年人。自然语言处理（NLP）方法将用于识别护理协调员在协调老年人护理时使用的干预措施和活动。NLP将人类生成的文本转换为机器可读的（结构化）信息。我们建议使用一种独特的迭代方法来进行NLP，其中从老年护理的现有电子医疗记录中提取可用的活动，而从第一次未发现足够信息的记录中手动识别新的活动。每次通过后，一个专家小组将检查提取的活动，以确保它们与护理协调相关。通过确定每种干预类别和目标最常发生的活动类型，以及哪些活动最能代表该类别和目标，将开发具有AIP和HHC代表性的干预概况。将制定干预措施的剂量概况，最后将比较AIP组和HHC组之间的住院、再住院、急诊室使用和费用的结果。

DESCRIPTION (provided by applicant): Recent research provides evidence that care coordination improves outcomes such as hospitalization, rehospitalization, emergency room use, and reduces cost. One program using nurse care coordination as an intervention to improve care for community dwelling older adults' was Aging in Place (AIP) at the University of Missouri's Sinclair School of Nursing. AIP's service provider for the enhanced nurse care coordination intervention was Senior Care, a home health agency and Home and Community Based service provider. After the AIP study ended Senior Care continued to exist as a home health care (HHC) agency. Taking advantage of the unique data from the AIP study, and the HHC agency we propose to perform a secondary analysis to (1) identify care coordination interventions, intervention activities, and intervention doses used by AIP nurse care coordinators using enhanced nurse coordination, and HHC nurses providing traditional HHC , (2) describe any differences in interventions used by AIP nurse care coordinators, and HHC nurses, and finally (3) to identify whether outcomes of hospitalization, rehospitalization, emergency room use, and cost differ for older adults in the AIP and HHC groups. The original AIP analysis did not link specific nurse care coordination interventions with outcomes, identify the specific activities associated with interventions, explore intervention dose, or compare outcomes to traditional HHC. Data will compare two groups of older people who received services, those with enhanced nurse care coordination in the AIP group from the years 2000-2002 and those who received traditional HHC without enhanced nurse care coordination from the years 2003-2005. Natural Language Processing (NLP) methods will be used to identify interventions and activities nurse care coordinators used when coordinating care for older adults. NLP transforms human-generated text into machine-readable (structured) information. We propose to use a unique iterative approach to NLP in which the available activities are extracted from existing electronic medical records from Senior Care, while new activities are identified by hand from records in which not enough information was found in the first pass. After each pass, a team of experts will check the extracted activities to assure that they are relevant to care coordination. Intervention profiles that are representative for AIP and HHC will be developed by determining what types of activities occur most frequently for each intervention category and target, and which ones are most representative of the category and target. Dose profiles of interventions will be developed, and finally, outcomes of hospitalization, rehospitalization, emergency room use, and cost will be compared between the AIP and HHC groups. PUBLIC HEALTH RELEVANCE: This study informs research and clinical practice by identifying actual care coordination intervention activities and dose, and developing intervention profiles for future use in research and practice. The Natural Language Processing method will add to our knowledge of how to successful use electronic medical record text data.