Hospital Adoption of Models of Care and Practices for Older Adults and Its Impact

描述（由申请人提供）：老年人是人口中增长最快的部分，更容易患急性疾病，并且占医院急性护理入院和住院天数的比例不成比例。在住院期间，他们也特别容易发生不良事件，如医院获得性感染、谵妄、福尔斯和压疮。为了改善老年人的护理服务，降低不良后果的风险，已经开发了几种针对住院老年人的护理模式。这些模式包括老年人专用单位或团队，谵妄预防模式和过渡性护理计划，以防止患者出院时的失误;它们已被证明能有效提高患者安全和护理质量。尽管这些模式和做法可能会提高老年人的护理质量，但人们对全国各地的医院如何在其护理服务系统中采用这些模式和做法知之甚少。随着人们越来越关注医院在患者护理方面的表现，了解医院如何实施护理模式和护理实践以提高质量，以及这些模式和实践如何与健康结果相关，将是指导进一步努力转变护理的重要一步。在这项研究中，我们将开发一个医院的调查工具，以表征服务和护理过程中所采用的医院提供照顾敏感的老年人。我们将把这个工具应用到全国各地的大量医院，利用已经建立的网络-护士改善保健系统老年人（NICHE）网络的400多家医院。利用调查数据，我们将制定一项措施，以描述医院采用老年人模式和做法的程度。我们将比较医院在这方面的措施，并检查其与病人的结果的关系。这些措施还可用于审查区域差异和长期差异。

DESCRIPTION (provided by applicant): Older adults, the fastest growing segment of the population, are more prone to acute illnesses, and account for a disproportionately high number of hospital acute care admissions and hospital days. They are also particularly at risk for adverse events such as hospital acquired infections, delirium, falls, and pressure ulcers during inpatient hospitalization. To improve care delivery for older adults and reduce risk of adverse outcomes, several models of care targeting hospitalized older adults have been developed. These models include dedicated units or teams for older adults, delirium prevention models, and transitional care programs to prevent lapses when patients are discharged from the hospital; they have been shown to be effective in improving patient safety and quality of care. Although these models and practices may improve quality of care among older adults, little is known about how hospitals across the country have adopted them in their care delivery systems. As increasing attention has been placed on hospital performance in patient care, understanding how hospitals implement care models and practices of care to improve quality and how these models and practices relate to health outcomes would be an important step toward guiding further efforts to transform care. In this study, we will develop a hospital survey tool to characterize services and processes of care adopted by hospitals to deliver care sensitive to older adults. We will apply this tool to a large number of hospitals across the country, utilizing n already established network-the Nurses Improving Care for Health system Elders (NICHE) network of over 400 hospitals. Using the survey data, we will develop a measure to describe the degree to which hospitals have adopted models and practices for older adults. We will compare hospitals on this measure and examine its relationship with patient outcomes. Such measures may also allow for the examination of regional variations and variations over time.