Comparative effectiveness of home care environments for diverse elders' outcomes

项目摘要 应聘者为社区/公共卫生护士和老年卫生服务研究员 致力于家庭健康服务系统的有效性比较研究。她的短期训练 目标是(1)发展比较有效性研究方法的专门知识和(2)数据管理 以及针对家庭保健数据集和研究设计问题的分析方法。长期研究 目标是改进设计和提供家庭保健护理结果，以应对快速老龄化和 人口日益多样化。除了重点研究外，职业发展计划还包括互动 与她的指导/研究团队中的同事一起，正式的课程工作将以相对有效的方式进行 研究方法。宾夕法尼亚大学将为她的职业生涯提供一个出色的环境 发展。资源包括接触知名的跨学科教员，他们通过Focus 卫生服务研究、老龄化和比较有效性研究中心 护理、医学、社会学、统计学和商业学院。在优秀导师的指导下，在一流的 培训环境，利用丰富的数据集和强大的初步数据，本提案涉及三个 具体目标：1)比较护理交付系统策略的有效性(更多护士在 学士学位水平、护理访问的“前置”和支持性机构的工作环境)以改善 家庭健康患者结局~2)确定护理是否以及在什么情况下对家庭的影响 健康结果取决于非正式照顾者的帮助，以及3)确定种族/民族的程度 家庭健康结果的差异，并确定哪些护理系统提供策略最有可能 与改善种族/少数民族患者和临床复杂的老年人的预后有关。 拟议的培训和研究将利用相对有效性方面的最新进展。 研究方法以检测家庭健康结果中的种族/民族差异，了解其影响因素 因素(个人、家庭、社区和卫生系统)，并评价 不同个体下改善家庭健康患者预后的护理服务体系策略 和社会环境环境。这一创新项目将利用一个独特的数据集，包括 提供有关护理和家庭健康工作环境的详细信息的护士调查 近250家家庭健康机构，为居住在不同社区的老年人提供服务。护士 调查结果与独立的家庭保健患者评估和结果数据相结合提供 了解每个患者的独特情况，包括他们健康状况的复杂性和严重性 和护理需求，以及关于他们的生活环境和非正式护理人员的信息。与以下方面的联系 其他管理和公共数据集将提供有关家庭健康的其他关键变量 机构服务模式和关于犯罪、隔离、社会经济地位和健康的社区措施 护理提供者的可用性/短缺。这项拟议的研究具有重要意义，因为它将突出 改善弱势人群患者预后的不同家庭健康护理提供策略 可能会实现。正在应对的挑战--如何最好地提供安全、有效和负担得起的住房 对不同患者的健康护理--影响从家到家的整个护理过程中的患者结局 医疗院和医院。可用于指导家庭保健系统管理员的证据有限 就家庭健康护理提供系统策略的利弊做出决定。最好的 家庭健康护理提供策略的组合可能会完全不同，具体取决于 非正式的家庭照顾者和社区支持的存在。专业的家庭健康护理和护理 非正式(非正式)或社区护理可以协同作用，以提高系统水平的有效性 例如，通过降低所需服务的强度进行干预。比较有效性研究 建议将形成翻译有效护理交付系统策略所需的关键证据 以证据为基础的实践建议，提供者、付款人、购买者、政策制定者和其他 原则性调查，公众可以信赖。

Project Summary The candidate is a community/public health nurse and gerontological health services researcher committed to comparative effectiveness research on home health delivery systems. Her short-term training objectives are (1) to develop comparative effectiveness research methods expertise and (2) data management and analytic methods specific to home health care datasets and research design issues. Long term research goals are to improve the design and deliver of home health nursing care outcomes for a rapidly aging and increasingly diverse population. In addition to focused research, career development plans include interaction with colleagues on her mentoring/research team, formal course work will be taken in comparative effectiveness research methods. The University of Pennsylvania will provide an outstanding environment for her career development. Resources include access to eminent interdisciplinary faculty who collaborate through focused Research Centers in Health Services Research, Aging and Comparative Effectiveness Research, across the Schools of Nursing, Medicine, Sociology, Statistics, and Business. Guided by excellent mentors, in a superb training environment, with access to rich datasets and strong preliminary data, this proposal addresses three specific aims: 1) Compare the effectiveness of nursing delivery system strategies (more nurses educated at the baccalaureate level, "front-loading" of nursing visits, and supportive agency work environments) to improve home health patient outcomes~ 2) Determine if and under what conditions the impact of nursing on home health outcomes is contingent upon informal caregiver assistance~ and 3) Determine the extent of racial/ethnic disparities in home health outcomes, and determine which nursing system delivery strategies are most likely to be associated with improved outcomes for racial/ethnic minority patients and clinically complex older adults. The proposed training and research will utilize the latest advances in comparative effectiveness research methods to detect racial/ethnic disparities in home health outcomes, understand the contributing factors (individual, family, community and health systems), and evaluate the comparative effectiveness of nursing delivery system strategies on improving outcomes for home health patients under different individual and socio-environmental circumstances. This innovative project will capitalize on a unique data set, comprised of nurse surveys providing detailed information about nursing care and work environment within home health agencies in nearly 250 home health agencies that serve older adults living in diverse communities. The nurse survey results combined with independent home health care patient assessment and outcomes data provides a window into each patient's unique circumstances, including the complexity and severity of their health status and care needs, as well as information about their living environment and informal caregivers. Linkages with additional administrative and public datasets will provide additional key variables regarding home health agency service patterns and community measures of crime, segregation, socio-economic status and health care provider availability/shortages. The proposed research is significant because it will highlight the value of different home health nursing delivery strategies for improving patient outcomes among vulnerable populations may be achieved. The challenge being addressed--how to best provide safe, effective, and affordable home health nursing care to diverse patients--affects patient outcomes across the continuum of care from home to medical home and hospital. Limited evidence is available to guide home health care systems administrators in making decisions about the pros and cons of home health nursing delivery system strategies. The best combination of home health nursing care delivery strategies may be categorically different depending on the presence of informal family caregivers and community supports. Professional home health nursing care and informal (lay) or community care may interact synergistically to increase the effectiveness of systems level intervention, for example, by reducing the intensity of services needed. The comparative effectiveness study proposed will form a critical body of evidence needed to translate effective nursing delivery system strategies into evidence-based practice recommendations that providers, payers, purchasers, policy makers, other principle investigators, and the public can trust.