Johnson Christopher E, Weech-Maldonado Robert, Reker Dean, Buchanan Robert, Laberge Alexandre
Texas A&M University System Health Science Center, Texas, USA.
Med Care Res Rev. 2007 Dec;64(6):673-90. doi: 10.1177/1077558707304740. Epub 2007 Sep 18.
This study compared the characteristics of community nursing homes where veterans received their care with those of facilities that did not treat veterans from 1999 to 2002 using the Centers for Medicare and Medicaid Services (CMS) Online Survey Certification and Reporting system data merged with the CMS Minimum Data Set. A structure, process, and outcome model was used to examine whether the presence of per diem veterans had any impact on multidimensional quality measures. Facilities with any veterans were less likely to meet recommended nurse staffing standards; more likely to have patients with tube feeding, new catheterizations, and mobility restraints; and more likely to have actual harm citations and new pressure sores, plus quality-of-care, quality-of-life, and total deficiencies, than facilities without veterans. The implications of this study are that the U.S. Department of Veterans Affairs may need to examine its contracting policies with community facilities to understand both quality and selection effects that may be occurring.
本研究利用医疗保险和医疗补助服务中心（CMS）在线调查认证与报告系统数据与CMS最小数据集合并后的数据，比较了1999年至2002年退伍军人接受护理的社区疗养院与不收治退伍军人的机构的特征。采用结构、过程和结果模型来检验按日计费的退伍军人的存在是否对多维度质量指标有任何影响。与没有退伍军人的机构相比，有任何退伍军人的机构更不可能达到推荐的护士人员配备标准；更有可能有接受管饲、新插管和行动受限的患者；更有可能有实际伤害引用和新的压疮，以及护理质量、生活质量和总缺陷。本研究的意义在于，美国退伍军人事务部可能需要审查其与社区机构的签约政策，以了解可能正在发生的质量和选择效应。
