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

 Natalie Leland博士是一名职业治疗研究员，其目标是成为康复健康服务研究的独立调查员，专注于开发以患者为导向的循证质量措施，促进提供者绩效改进，并提高以患者为中心的结果。拟议的奖项将通过扩大她在利益相关者参与，质量措施开发，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的丰富资产，包括国家认可的NIH资助的老年学、卫生政策和经济学导师。Leland博士提出的K01研究的目标是在跌倒预防领域制定以患者为中心的循证康复服务质量措施。预计这些信息将通过确定康复文件（以及可能的康复实践）中的差距，从而为提高康复服务质量提供信息，从而最大限度地减少跌倒率。尽管预防性干预有可能降低跌倒风险，但急性护理后患者继续跌倒，导致不良结局（例如，再住院）和不必要的医疗费用。因此，人们严重关切在康复环境中提供循证治疗的程度。提高跌倒率的最有效策略是确保提供与高质量护理相关的跌倒预防干预措施并随后记录在案。初级保健医生已经成功地实施了一项协议，制定了跌倒预防质量措施，从定义最低护理标准开始，并提高了医生的表现，改善了患者的预后。因此，改善髋部骨折患者康复结果的第一步是确定最低护理标准，以便识别康复护理中的缺陷并随后加以改善。为了确保开发由患者驱动的质量措施，Leland博士将整合定性和定量方法，以确定预防跌倒的高质量髋部骨折康复。这些研究结果将作为初步数据，在以后的R01提案中使用电子健康记录，从全国代表性的样本康复提供者在纵向比较有效性研究。该研究将评估髋部骨折患者接受优先跌倒预防护理在多大程度上改善了以患者为中心的结局。确定康复机构的最低护理标准是促进减少福尔斯的高质量康复的关键第一步。目前的研究是直接响应AHRQ的使命，提高质量，安全， 为所有美国人提供医疗保健的效率和功效。此外，在借鉴洛杉矶城市老年人康复人口的多样性时，将包括多个AHRQ优先人口，如少数民族、残疾人或多种慢性病患者和妇女。

 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.