A National Report of Nursing Home Quality Measures and Information Technology

摘要： 在这份《护理之家质量措施和信息技术国家报告》中，AHRQ将支持一项 跨学科研究团队已经在长期护理环境中为临床研究做出贡献。的 PI是一名拥有博士学位的注册护士，也是美国护理学院的研究员，拥有二十多年的工作经验 在不同的项目、环境和学科中。研究策略包括三波、纵向、 重复测量研究测量信息技术复杂性（ITS）在一个国家的样本， 疗养院（NH）。方法包括检查NH ITS和国家之间的关系- 报告的、公开可用的NH质量指标，可通过Nursing Home Compare和OSCAR获得 连续三年具体目标是：1）描述由以下因素决定的总体ITS的变化模式： 总体ITS随时间的变化，并检查ITS和NH属性变化之间的联系，2）检查 总体ITS变化的模式是否与质量测量得分超过3的变化相关 3）调查特定类型的ITS评分（领域和维度），NH之间的关系 属性（人员配备、设施和市场特征）和NH质量指标。ITS已被用于 描述用于支持三个卫生保健领域（包括住院医师护理）的IT和软件的多样性， 临床支持和管理活动。对报告的质量指标进行风险调整，以说明 居民敏锐度的变化，以便可以比较每个机构提供的护理。该项目高度 创新;国家卫生信息技术评估以前没有与国家卫生质量措施联系起来。 这项研究包括一项调查的ITS在全国代表性的样本，包括10%的nhs招募从 美国各州（N = 1，570）。我们将在分析中采用混合模型方法 包括NH质量测量作为从属，时间和9种不同类型的ITS作为独立 变量，分别。在目标1中，我们将评估在三个维度（功能， 技术和一体化），包括使用的信息技术类型、使用信息技术的程度以及外部和 内部IT整合。ITS还将在三个卫生保健领域进行测量，包括居民 护理、临床支持和管理活动。在目标2中，我们将研究NH ITS之间的关联， 选择NH属性和全国报告的护理之家比较质量措施。我们将描述 3年内的总体ITS模式为增加、稳定、减少或不稳定（不稳定）。我们将整合 经典的计量经济学方法，通过使用NH属性来校正IT的潜在内生性，包括 人员配备、设施和市场特征作为混合模型方法中的协变量，包括多变量 回归，动态面板模型分析，和工具变量技术。

Abstract: In this National Report of Nursing Home Quality Measures and Information Technology AHRQ will support an interdisciplinary research team who are already contributing to clinical research in long-term care settings. The PI is a doctorally-prepared RN and fellow in the American Academy of Nursing with over two decades of work in diverse projects, settings, and disciplines. The research strategy includes a three-wave, longitudinal, repeated measures study measuring Information Technology Sophistication (ITS) in a national sample of nursing homes (NH). Methods include an examination of the relationships between NH ITS and nationally- reported, publicly-available NH Quality Measures available through Nursing Home Compare and OSCAR over three consecutive years. Specific aims are: 1) Describe the pattern of changes in overall ITS determined by changes in overall ITS over time and examine links between the changes in ITS and NH attributes, 2) Examine whether patterns of overall ITS changes are associated with the changes in Quality Measure scores over 3 years, and 3) Investigate relationships between specific types of ITS scores (Domains and Dimensions), NH attributes (Staffing, Facility, and Market Characteristics), and NH Quality Measures. ITS has been used to describe the diversity of IT and software used to support three domains of health care including Resident Care, Clinical Support, and Administrative Activities. Reported Quality Measures are risk-adjusted to account for variations in resident acuity so that care delivered in each facility can be compared. The project is highly innovative; national assessments of NH IT have not been linked previously with national NH Quality Measures. This study includes a survey of ITS in a nationally representative sample including 10% of NHs recruited from each state in the United States (N=1,570). We will incorporate a mixed model approach in our analysis including NH Quality Measures as the dependent, and Time and 9 different types of ITS as independent variables, respectively. In Aim 1 we will assess NH ITS measured in three dimensions (Functional, Technological, and Integration) including types of IT used, extent of use of IT, and degree of external and internal IT integration, respectively. ITS will also be measured in three health care domains including Resident Care, Clinical Support, and Administrative Activities. In Aim 2, we will examine associations between NH ITS, select NH attributes, and nationally reported Nursing Home Compare Quality Measures. We will characterize patterns of overall ITS over 3 years as increasing, stable, decreasing, or unstable (erratic). We will integrate classical econometric methods to correct for potential endogeneity of IT by using NH attributes including Staffing, Facility, and Market Characteristics as covariates in a mixed model approach including multivariate regression, dynamic panel model analysis, and an instrumental variable technique.