Comparative and Cost Effectiveness Analyses of HAI Reduction in Nursing Homes

描述（由申请人提供）：疗养院（NH）中的医疗保健相关感染（HAI）是一个通常可以避免的主要安全问题。对于居住在NH的居民来说，感染是住院的最常见原因之一，也是发病和死亡的主要原因。与HAI相关的NH住院费用昂贵，通常是可以预防的，并且可能与负面健康结果相关。由于NHS的大部分护理是由护理人员提供的，因此了解这支劳动力如何为这一快速增长的人口提供安全，高质量，具有成本效益的护理至关重要。虽然护士的人员配置和不良后果之间的关联，如感染，在医院有很好的记录，证据基础，检查这些关系在NH是有限的，主要是横截面。以前的研究已经研究了护士劳动力的特点对护理质量的影响，在NHS，然而，研究护士劳动力的特点，特别是对HAI和居民急性转移的影响是有限的。此外，经济学研究的成本和效益的最佳护士配备和减少居民的不良后果是稀疏的。没有发表的研究同时审查了改善有效的结构和护理过程，以减少HAI在NH的成本效益。建立在一个更大的研究工作，并获得了一个独特的纵向数据集从退伍军人管理局（VA）NH设施的财政年度2003年至2009年，这项拟议的论文研究将研究护理投入对居民护理过程和结果的影响（即，HAI和居民转移到医院）。具体而言，申请人将确定影响HAI结果和成本的NH护理的有效结构和流程。这项研究将告知NH卫生服务研究的经验证据基础，这将是有益的卫生政策制定者和NH管理者。申请人的长期目标是开发一个跨学科的研究计划，以提高老年人的护理质量，通过产生知识，为有效的卫生政策提供信息，最终目标是提高NH居民的生活质量和安全。因此，该项目的目标与NINR的预防、疾病预防和改善NH居民生活质量战略计划相一致。该提案也与NINR培训未来护士科学家的目标密切相关，以采用创新方法，如比较有效性和经济分析，以推进健康科学和优质护理。 公共卫生相关性：养老院（NH）中的医疗相关感染（HAI）是一个通常可以避免的主要安全问题。NHS的大部分护理是由护理人员提供的;了解这支队伍如何为这一快速增长的人口提供安全，高质量，具有成本效益的护理至关重要。确定有效的护理结构和流程，以提高NH护理的质量和成本效益，以减少HAI，将为未来的临床实践和卫生政策提供信息。

DESCRIPTION (provided by applicant): Healthcare associated infections (HAIs) in nursing homes (NHs) are a major safety issue that is often avoidable. For residents living in NHs, infections are among the most common reasons for hospitalizations and are a leading cause of morbidity and mortality. NH hospitalizations related to HAIs are costly, often preventable, and potentially associated with negative health outcomes. Because the majority of care in NHs is provided by nursing personnel, understanding how this workforce provides safe, high quality, cost-efficient care to this rapidly growing population is critical. While associations between nurs staffing and adverse outcomes such as infections are well documented in hospitals, the evidence base that examines these relationships in NHs is limited and is mainly cross sectional. Previous studies have examined the influence of nurse workforce characteristics on quality of care in NHs; however, research examining the impact of nurse workforce characteristics specifically on HAIs and resident acute transfers are limited. Further, economic studies examining the costs and benefits of optimal nurse staffing and decreased resident adverse outcomes are sparse. No published research has simultaneously examined the cost-effectiveness of improving efficacious structures and processes of care for HAI reduction in NHs. Building on the work of a larger study and having access to a unique longitudinal dataset from the Veterans Administration (VA) NH facilities for fiscal years 2003 through 2009, this proposed dissertation study will examine the impact of nursing inputs on resident care processes and outcomes (i.e., HAIs and resident transfers to hospitals). Specifically, the applicant will identify efficacious structures and processes of NH care that impact HAI outcomes and costs. This study will inform the empirical evidence base in NH health services research that will be useful to health policy makers and NH administrators. The applicant's long-term goal is to develop an interdisciplinary program of research to improve the quality of care for older adults by generating knowledge to inform effective health policies with the ultimate goal of promoting quality of life and safety for NH residents. As such, the goals of this project are in alignment with those of the NINR Strategic Plan of caregiving, disease prevention, and improving the quality of life for NH residents. The proposal is also closely aligned with NINR's goals for training future nurse scientists to employ innovative methods such as comparative effectiveness and economic analyses to advance the science of health and quality care. PUBLIC HEALTH RELEVANCE: Healthcare associated infections (HAIs) in nursing homes (NHs) are a major safety issue that is often avoidable. The majority of care in NHs is provided by nursing personnel; understanding how this workforce provides safe, high quality, cost-efficient care to this rapidly growing population is critical. Identifying efficacious structures ad processes of care to improve the quality of and cost-effectiveness of NH care to reduce HAIs will inform future clinical practice and health policy.