Comparative and Cost Effectiveness Analyses of HAI Reduction in Nursing Homes

描述（由申请人提供）：医疗保健相关感染（HAIs）在养老院（NHs）是一个主要的安全问题，通常是可以避免的。对于生活在NHs的居民来说，感染是最常见的住院原因之一，也是发病率和死亡率的主要原因。与健康照护相关的非健康照护住院费用昂贵，通常可预防，并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，因此了解这些劳动力如何为这一快速增长的人口提供安全、高质量、高成本效益的护理至关重要。虽然护士人员配备与感染等不良后果之间的关联在医院中有很好的记录，但在NHs中检验这些关系的证据基础有限，而且主要是横断面的。以前的研究已经检查了护士劳动力特征对NHs护理质量的影响；然而，研究人员的特点，特别是对卫生保健和住院急性病转移护士的影响是有限的。此外，经济研究检查成本和效益的最佳护士配备和减少住院不良后果是稀疏的。没有发表的研究同时检查了改善国民保健制度中减少HAI的有效结构和护理过程的成本效益。在一项大型研究的基础上，并获得2003至2009财政年度退伍军人管理局（VA） NH设施的独特纵向数据集，本论文将研究护理投入对住院护理过程和结果的影响（即，HAIs和住院医生转院）。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。本研究将为新卫生保健服务研究提供实证依据，对卫生政策制定者和新卫生保健管理者有益。申请人的长期目标是制定一个跨学科的研究方案，通过产生知识，为有效的卫生政策提供信息，从而提高老年人的护理质量，最终目标是提高新西兰居民的生活质量和安全。因此，这一项目的目标与nnr关于护理、疾病预防和改善北海省居民生活质量的战略计划相一致。该建议也与国家护士研究所培训未来护士科学家的目标密切一致，这些护士科学家采用创新方法，如比较有效性和经济分析，以推进卫生和优质护理科学。

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.