Using Patient Centered Outcomes Research to Examine Consistent Resident Assignmen

描述（由申请人提供）：本申请由匹兹堡大学卫生政策与管理系（HPM）教授（终身）尼古拉斯·卡斯尔提供。我的长期职业目标是运用我在养老院运营方面的知识来提高居民护理的质量。作为PAR-12-115（K18）的一部分，我制定了与评估卫生服务系统干预措施的益处和危害相关的目标，以告知决策，并强调对人们重要的比较和结果。这是在重点领域的护理提供和协调慢性病患者。作为实现这些目标的建议的一部分，包括以下步骤：1）完成比较有效性研究方法中的研究方法课程; 2）进行指导良好，严格的以患者为中心的成果研究（PCOR）; 3）参加适当的研究会议，研讨会和国家会议;以及，4）限制教学和行政活动。具体的研究建议是检查使用一致的分配护士助理在养老院。一致分配的好处是：它提高了护理质量，减少了工作人员的流动，并受到工作人员的青睐。然而，这些信念是基于非常少的经验证据。因此，审查一贯分配的影响是重要的，特别是如果它继续作为改善护理的一种手段加以推广。目前还不清楚有多少养老院使用一致的分配。关于以患者为中心的结局（PCO）;理论上，认为护士助理的一致分配可以加强工作人员对住院医师护理要求的熟悉程度。因此，护理方面应该有所改善。然而，没有严格的实证研究已经审查了一致的分配与PCO的关联。因此，在本提案中，我将研究（1）护理助理在养老院的一致性分配的程度和水平;（2）护理助理在养老院的一致性分配对PCO的影响;（3）模拟与特定政策相关的结果，（不需要）护士助手一致的分配;以及（4）识别（并分配）促进成功实施和使用一致性分配的关键因素。这些活动将对养老院居民的护理产生深远的影响。

DESCRIPTION (provided by applicant): This application is provided by Nicholas Castle, a professor (tenured) in the Department of Health Policy & Administration (HPM), at the University of Pittsburgh. My long-term career goal is to apply my knowledge of nursing home operations to improve quality of resident care. As part of PAR-12-115 (K18) I have developed goals related to assessing the benefits and harms of health delivery system interventions to inform decision-making and, highlighting comparisons and outcomes that matter to people. This is in the emphasis area of care delivery and coordination for chronic care patients. The following steps are included as part of this proposal to achieve these objectives: 1) completing coursework in research methods in comparative effectiveness research methodology; 2) conducting well-mentored, rigorous patient-centered outcomes research (PCOR); 3) attending appropriate research meetings, seminars, and national conferences; and, 4) limiting teaching and administrative activities. The specific research proposed is to examine the use of consistent assignment of Nurse Aides in nursing homes. Touted benefits of consistent assignment are that: it improves quality of care, reduces staff turnover, and is preferred by staff. However, these beliefs are based on very little empirical evidence. Examining the impact of consistent assignment is thus significant, especially if it continues to be promoted as a means of improving care. It is uncertain how many nursing homes use consistent assignment. With respect to Patient Centered Outcomes (PCO); theoretically, consistent assignment of Nurse Aides is believed to strengthen the familiarity of staff with residents care requirements. As such, improvements in care should result. However, no rigorous empirical studies have examined the association of consistent assignment with PCO. Thus, in this proposal I will examine (1) the extent and level of consistent assignment in nursing homes of Nurse Aides; (2) the influence of Nurse Aide consistent assignment in nursing homes on PCO; (3) simulate outcomes related to specific policies requiring (and not requiring) Nurse Aide consistent assignment; and (4) identify (and distribute) key factors promoting successful implementation and use of consistent assignment. These activities will have a profound influence on the care of residents in nursing homes.