Identifying Patient-Centered Fall Prevention Care Processes in Hip Fracture Rehabilitation

 描述(申请人提供)：娜塔莉·利兰博士是一名职业治疗研究员，他的目标是成为康复健康服务研究的独立研究员，专注于开发利益相关者驱动的循证质量衡量标准，促进提供者业绩改进，并增强以患者为中心的结果。拟议的奖励将通过扩大她在利益相关者参与、质量测量开发、电子健康记录的使用和医疗保健政策方面的能力来促进这一目标。利兰博士将利用南加州大学现有的丰富资产，包括国家公认的NIH资助的老年学、卫生政策和经济学导师。利兰博士提出的K01研究的目标是开发以患者为中心、以证据为基础的康复服务质量衡量标准，以预防跌倒。这些信息预计将通过确定康复文件(可能还有康复实践)中的差距，从而提供改善康复服务质量的机会，从而最大限度地减少堕落率。尽管预防性干预有可能降低跌倒风险，但急性后护理患者继续下降，导致结果较差(例如，再次住院)和不必要的医疗成本。因此，在康复环境中提供循证治疗的程度令人严重关切。提高跌倒发生率的最有效战略是确保与高质量护理相关的预防跌倒干预措施的交付和随后的记录。初级保健医生已经成功地实施了一项制定预防跌倒质量措施的方案，该方案首先确定了护理的最低标准，并导致了医生业绩的改善和患者的更好结果。因此，改善髋部骨折患者康复效果的第一步是确定最低护理标准，以便能够识别康复护理中的缺陷并随后加以改善。为了确保制定利益相关者驱动的质量衡量标准，利兰博士将结合定性和定量方法，定义用于预防跌倒的高质量髋部骨折康复。这些发现将被用作后来的R01提案中的初步数据，使用来自全国具有代表性的康复提供者样本的电子健康记录进行纵向比较有效性研究。这项研究将评估接受髋部骨折患者优先预防跌倒护理在多大程度上改善了以患者为中心的结果。确定康复环境的最低护理标准是促进减少跌倒的高质量康复的关键第一步。目前的研究直接响应了AHRQ的使命，即提高质量，安全， 所有美国人的医疗保健的效率和效力。此外，在利用洛杉矶市区老年人康复人口的多样性时，将包括少数族裔、残疾或多种慢性病患者和妇女等多种AHRQ优先群体。

 DESCRIPTION (provided by applicant): Dr. Natalie Leland is an occupational therapy researcher whose goal is to become an independent investigator in rehabilitation health services research, focusing on developing stakeholder-driven evidence-based quality measures, facilitating provider performance improvement, and enhancing patient-centered outcomes. The proposed award will facilitate this goal by expanding her competencies in stakeholder engagement, quality measure development, use of electronic health records, and healthcare policy. Dr. Leland will capitalize on the wealth of assets available at the University o Southern California, including nationally recognized NIH-funded mentors in gerontology, health policy, and economics. The goal of Dr. Leland's proposed K01 research is to develop patient-centered evidence-based quality measures of rehabilitation services in the area fall prevention. Such information is expected to minimize fall rates by defining gaps in rehabilitation documentation (and presumably rehabilitation practice) and thus informing opportunities for improving the quality of rehabilitation services. Despite preventative interventions that have the potential to decrease fall risk, post-acute care patients continue to fall, resulting in poor outcomes (e.g., rehospitalization) and unnecessary healthcare costs. As a result, there is serious concern about the extent to which evidence-based treatments are provided in rehabilitation settings. The most effective strategy for improving fall rates is to ensure the delivery and subsequent documentation of fall prevention interventions that are associated with high quality care. Primary care physicians have successfully implemented a protocol for the development of fall prevention quality measures, which begins by defining minimum standards for care, and has resulted in improved physician performance, and better patient outcomes. Thus, the first step towards improving outcomes for hip fracture patients in rehabilitation is to define the minimum standards of care so deficiencies in rehabilitation care can be identified and subsequently ameliorated. To ensure the development of stakeholder-driven quality measures, Dr. Leland will integrate qualitative and quantitative approaches to define high quality hip fracture rehabilitation for fall prevention. These findings will be used as preliminary data in a later R01 proposal using electronic health records from a nationally representative sample of rehabilitation providers in a longitudinal comparative effectiveness study. That study will evaluate the extent to which receipt of prioritized fall prevention care for hip fracture patients results in improved patient-centered outcomes. Defining the minimum standards of care for rehabilitation settings is a critical first step in facilitating high quality rehabilitation that dcreases falls. The current study is directly responsive to AHRQ's mission of improving the quality, safety, efficiency, and efficacy of health care for all Americans. Further, in drawing on the diversity of the older adult rehabilitation population in urban Los Angeles, multiple AHRQ priority populations will be included such as minorities, individuals with disabilities or multiple chronic conditions, and women.