养老院质量指标与可预防住院治疗之间的关系。
Relationship between nursing home quality indicators and potentially preventable hospitalisation.
机构信息
School of Nursing, Purdue University, West Lafayette, Indiana, USA
Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.
出版信息
BMJ Qual Saf. 2019 Jul;28(7):524-533. doi: 10.1136/bmjqs-2018-008924. Epub 2019 Mar 13.
BACKGROUND
Hospitalisations are very common among nursing home residents and many of these are deemed inappropriate or preventable. Little is known about whether clinical care quality is related to hospitalisation, especially potentially preventable hospitalisations (PPHs). Among the few studies that have been conducted, the findings have been inconsistent. The objective of this study was to examine the relationship between quality indicators and overall and PPHs among Medicaid beneficiaries aged 65 years and older receiving care at nursing homes in Minnesota.
METHODS
23 risk-adjusted quality indicators were used to assess nursing home quality of care. Quality indicators and other facility-level variables from the Minnesota Nursing Home Report Card were merged with resident-level variables from the Minimum Data Set. These merged data were linked with Medicaid claims to obtain hospitalisation rates during the 2011-2012 period. The sample consisted of a cohort of 20 518 Medicaid beneficiaries aged 65 years and older who resided in 345 Minnesota nursing homes. The analyses controlled for resident and facility characteristics using the generalised linear mixed model.
RESULTS
The results showed that about 44 % of hospitalisations were PPHs. Available quality indicators were not strongly or consistently associated with the risk of hospitalisation (neither overall nor PPH). Among these 23 quality indicators, five quality indicators (antipsychotics without a diagnosis of psychosis, unexplained weight loss, pressures sores, bladder continence and activities of daily living [ADL] dependence) were related significantly to hospitalisation and only four quality indicators (antipsychotics without a diagnosis of psychosis, unexplained weight loss, ADL dependence and urinary tract infections) were related to PPH.
CONCLUSION
Although general quality indicators can be informative about overall nursing home performance, only selected quality indicators appear to tap dimensions of clinical quality directly related to hospitalisations.
背景
养老院居民经常住院，其中许多住院被认为是不合适或可预防的。关于临床护理质量是否与住院相关，尤其是潜在可预防的住院（PPH）相关，知之甚少。在为数不多的已进行的研究中，研究结果并不一致。本研究旨在检查明尼苏达州养老院接受医疗补助（Medicaid）的 65 岁及以上居民的质量指标与总体住院率和 PPH 之间的关系。
方法
使用 23 个风险调整后的质量指标来评估养老院的护理质量。明尼苏达州养老院报告卡中的质量指标和其他设施水平变量与最小数据集（Minimum Data Set）中的居民水平变量合并。这些合并的数据与医疗补助索赔相关联，以获得 2011-2012 年期间的住院率。该样本由明尼苏达州 345 家养老院的 20518 名 65 岁及以上的 Medicaid 受益人的队列组成。使用广义线性混合模型对居民和设施特征进行了控制。
结果
结果表明，约 44%的住院是 PPH。可用的质量指标与住院风险（无论是总体风险还是 PPH 风险）没有很强或一致的关联。在这 23 个质量指标中，有 5 个质量指标（无精神病史使用抗精神病药物、不明原因体重减轻、压疮、膀胱控尿和日常生活活动（ADL）依赖）与住院显著相关，只有 4 个质量指标（无精神病史使用抗精神病药物、不明原因体重减轻、ADL 依赖和尿路感染）与 PPH 相关。
结论
尽管一般质量指标可以提供有关养老院整体表现的信息，但只有选定的质量指标似乎可以直接反映与住院相关的临床质量维度。
Zotero 插件