养老院比较下的质量改进：过程和结果测量指标变化之间的关系。
Quality improvement under nursing home compare: the association between changes in process and outcome measures.
机构信息
Center for Health Equity Research and Promotion, Philadelphia VAMC and Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
出版信息
Med Care. 2013 Jul;51(7):582-8. doi: 10.1097/MLR.0b013e31828dbae4.
BACKGROUND
Changes in resident outcomes may be driven by many factors, including changes in nursing home care processes. Understanding what processes, if any, lead to successful improvements in resident outcomes could create a stronger case for the continued use of these outcome measures in nursing home report cards.
OBJECTIVE
To test the extent to which improvements in outcomes of care are explained by changes in nursing home processes, a setting where, to our knowledge, this link has not been previously studied. RESEARCH DESIGN/MEASURES: We describe facility-level changes in resident processes and outcomes before and after outcomes were publicly reported. We then assess the extent to which the changes in outcomes are associated with changes in nursing home processes of care, using the public release of information on nursing home outcomes as a source of variation in nursing home outcomes to identify the process-outcome relationship.
SUBJECTS
All 16,623 US nursing homes included in public reporting from 2000 to 2009 in Online Survey, Certification and Reporting and the nursing home Minimum Data Set.
RESULTS
Of the 5 outcome measures examined, only improvements in the percentage of nursing home residents in moderate or severe pain were associated with changes in nursing home processes of care. Furthermore, these changes in the measured process of care explained only a small part of the overall improvement in pain prevalence.
CONCLUSIONS
A large portion of the improvements in nursing home outcomes were not associated with changes in measured processes of care suggesting that processes of care typically measured in nursing homes do little to improve nursing home performance on outcome measures. Developing quality measures that are related improved patient outcomes would likely benefit quality improvement. Understanding the mechanism behind improvements in nursing home outcomes is key to successfully achieving broad quality improvements across nursing homes.
背景
居民结果的变化可能由多种因素驱动，包括养老院护理流程的变化。了解哪些流程（如果有）导致居民结果的成功改善，可以为在养老院报告卡中继续使用这些结果衡量标准提供更有力的依据。
目的
测试护理院流程的变化在多大程度上解释了护理结果的改善，在我们所知的情况下，这一联系在护理院中尚未得到过研究。
研究设计/测量：我们描述了居民结果在公开报告前后的机构层面的变化。然后，我们评估了结果变化与护理院护理过程变化之间的关联程度，利用护理院结果的公开信息发布作为护理院结果变化的来源，以确定流程-结果关系。
研究对象
2000 年至 2009 年期间，在线调查、认证和报告以及养老院最低数据集纳入了所有 16623 家参与公开报告的美国养老院。
结果
在检查的 5 项结果衡量标准中，只有养老院中度或重度疼痛居民的比例提高与护理院护理过程的变化相关。此外，这些经过测量的护理过程变化仅解释了疼痛流行率总体改善的一小部分。
结论
养老院结果的大部分改善与测量的护理过程变化无关，这表明养老院中通常测量的护理过程对改善养老院在结果衡量标准上的表现作用不大。开发与改善患者结果相关的质量衡量标准可能会有益于质量改进。了解养老院结果改善背后的机制是在养老院中成功实现广泛质量改进的关键。
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