养老院护理中的量效关系：对长期护理居民功能下降的考察。
The volume-outcome relationship in nursing home care: an examination of functional decline among long-term care residents.
机构信息
Health Policy Research Institute, and Department of Medicine, University of California, Irvine, CA 92697, USA.
出版信息
Med Care. 2010 Jan;48(1):52-7. doi: 10.1097/MLR.0b013e3181bd4603.
BACKGROUND
Extensive evidence has demonstrated a relationship between patient volume and improved clinical outcomes in hospital care. This study sought to determine whether a similar association exists between nursing home volume of long-term care residents and rates of decline in physical function.
METHODS
We conducted retrospective analyses on the 2004 and 2005 Minimum Data Set files that contain 605,433 eligible long-term residents in 9336 nursing homes. The outcome was defined following the federal "Nursing Home Compare" measure that captures changes in 4 basic activities of daily living status between 2 consecutive quarters. Both the outcome measure and nursing home volume were defined on the basis of long-term care residents. We estimated random-effects logistic regression models to quantify the independent impact of volume on functional decline.
RESULTS
As volume increased, nursing home's unadjusted rate of functional decline tended to be lower. After multivariate adjustment for baseline resident characteristics and the nesting of residents within facilities, the odds ratio of activities of daily living decline was 0.82 (95% confidence interval: 0.79-0.86, P < 0.000) for residents in high-volume nursing homes (>101 residents/facility), compared with residents in low-volume facilities (30-51 residents/facility).
CONCLUSIONS
High volume of long-term care residents in a nursing home is associated with overall less functional decline. Further studies are needed to test other important nursing home outcomes, and explore various institutional, staffing, and resource attributes that underlie this volume-outcome association for long-term care. Understanding how greater experience of high-volume facilities leads to better resident outcome may help guide quality improvement efforts in nursing homes.
背景
大量证据表明，医院护理的患者数量与临床结果的改善之间存在关系。本研究旨在确定长期护理居民的养老院数量与身体功能下降率之间是否存在类似的关联。
方法
我们对包含 9336 家养老院中 605433 名合格长期居民的 2004 年和 2005 年最低数据集中的文件进行了回顾性分析。该结果是根据联邦“养老院比较”措施定义的，该措施捕捉了两个连续季度之间 4 项基本日常生活活动状态的变化。结果衡量标准和养老院数量都是基于长期护理居民定义的。我们估计了随机效应逻辑回归模型，以量化数量对功能下降的独立影响。
结果
随着数量的增加，养老院未经调整的功能下降率趋于降低。在对居民入住前的特征和居民在设施内的嵌套进行多变量调整后，高容量养老院（>101 名居民/设施）居民的日常生活活动下降的优势比为 0.82（95%置信区间：0.79-0.86，P<0.000），而低容量设施（30-51 名居民/设施）居民的优势比为 1.00。
结论
养老院中大量的长期护理居民与整体功能下降较少有关。需要进一步研究来测试其他重要的养老院结果，并探讨长期护理中存在这种数量-结果关联的各种机构、人员配备和资源属性。了解高容量设施的更多经验如何导致更好的居民结果，可能有助于指导养老院的质量改进工作。
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