RESUMO
BACKGROUND: Interventions to improve the fracture prevention in nursing homes are needed. METHODS: Cluster-randomized, single-blind, controlled trial of a multi-modal quality improvement intervention. Nursing homes (n=67) with > or =10 residents with a diagnosis of osteoporosis or recent hip fracture (n=606) were randomized to receive an early or delayed intervention consisting of audit and feedback, educational modules, teleconferences, and academic detailing. Medical record abstraction and the Minimum Data Set were used to measure the prescription of osteoporosis therapies before and after the intervention period. Analysis was at the facility-level and Generalized Estimating Equation modeling was used to account for clustering. RESULTS: No significant improvements were observed in any of the quality indicators. The use of osteoporosis pharmacotherapy or hip protectors improved by 8.0% in the intervention group and 0.6% in the control group, but the difference was not statistically significant (P=.72). Participation in the intervention activities was low, but completion of the educational module (odds ratio [OR] 4.8, 95% confidence interval [CI], 1.9-12.0) and direct physician contact by an academic detailer (OR 4.5, 95% CI, 1.1-18.2) were significantly associated with prescription of osteoporosis pharmacotherapy or hip protectors in multivariable models. CONCLUSIONS: Audit-feedback and education interventions were ineffective in improving fracture prevention in the nursing home setting, although results may have been tempered by low participation in the intervention activities.
Assuntos
Fraturas Ósseas/prevenção & controle , Instituição de Longa Permanência para Idosos , Casas de Saúde , Garantia da Qualidade dos Cuidados de Saúde/métodos , Idoso , Idoso de 80 Anos ou mais , Arizona , Feminino , Fraturas Ósseas/etiologia , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , North Carolina , Razão de Chances , Osteoporose/complicações , Osteoporose/prevenção & controle , Avaliação de Processos e Resultados em Cuidados de Saúde , Método Simples-CegoRESUMO
The Centers for Medicare & Medicaid Services, a federal agency of the U.S. Department of Health and Human Services, has released new data about the quality of care provided by Medicare-certified home health agencies as part of an expanding initiative to continue to improve the home care services that are provided to millions of Americans. The initiative combines information about the quality of care provided by individual home health agencies-for use by consumers, their families, and healthcare professionals-with important resources to assist home health agencies working to improve quality of care. This article provides an overview of that initiative, and discusses information available on the Home Health Compare Web site that case managers and discharge planners will find useful for helping patients and their families select a home health agency.
Assuntos
Benchmarking , Serviços de Assistência Domiciliar/normas , Serviços de Informação , Internet , Alta do Paciente , Centers for Medicare and Medicaid Services, U.S. , Humanos , Indicadores de Qualidade em Assistência à Saúde , Estados UnidosRESUMO
The Centers for Medicare & Medicaid Services (CMS), a federal agency of the U.S. Department of Health and Human Services, has released new data about the quality of care provided by Medicare-certified home health agencies as part of an expanding initiative to continue to improve the home care services that are provided to millions of Americans. The initiative combines information about the quality of care provided by individual home health agencies-for use by consumers, their families, and health care professionals-with important resources to assist home health agencies working to improve quality of care. This article provides an overview of that initiative, and discusses information available on the Home Health Compare Web site that case managers and discharge planners will find useful for helping patients and their families select a home health agency.
Assuntos
Enfermagem em Saúde Comunitária , Continuidade da Assistência ao Paciente/organização & administração , Agências de Assistência Domiciliar , Internet , Feminino , Humanos , Disseminação de Informação , Masculino , Medicare/organização & administração , Alta do Paciente , Avaliação de Programas e Projetos de Saúde , Qualidade da Assistência à Saúde , Estados UnidosRESUMO
The U.S. Department of Health and Human Services has launched a Nursing Home Quality Initiative that provides nursing home consumers and healthcare professionals with publicly reported quality information about every Medicare- or Medicaid-certified nursing facility in the United States. The initiative also offers assistance to nursing homes in their continuing efforts to improve the quality of the care they offer. This article provides an overview of that initiative, and discusses information available on the Nursing Home Compare Web site that case managers will find useful for helping clients in their nursing home decision-making process.
