Cathleen S Colón-Emeric1, Kirsten N Corazzini2, Eleanor S McConnell3, Wei Pan4, Mark P Toles5, Rasheeda Hall6, Melissa Batchelor-Murphy4, Tracey L Yap4, Amber L Anderson4, Andrew Burd4, Sathya Amarasekara4, Ruth A Anderson5. 1. Duke University School of Medicine, Durham, NC; Durham VA Geriatric Research Education and Clinical Center, Durham, NC. Electronic address: Cathleen.colonemeric@duke.edu. 2. Duke University School of Medicine, Durham, NC; Duke University School of Nursing, Durham, NC. 3. Durham VA Geriatric Research Education and Clinical Center, Durham, NC; Duke University School of Nursing, Durham, NC. 4. Duke University School of Nursing, Durham, NC. 5. University of North Carolina School of Nursing, Chapel Hill, NC. 6. Duke University School of Medicine, Durham, NC.
Abstract
OBJECTIVES: Validated process measures that correlate with patient outcomes are needed for research and quality improvement. DESIGN: Cross-sectional analysis within a cluster-randomized fall prevention study. SETTING: Nursing homes in North Carolina (n = 16). PARTICIPANTS: Nursing home staff (n = 541) and residents with 1 or more falls in 6 months (n = 597). MEASUREMENTS: Fall-prevention process measures in 4 categories derived from Assessing Care of Vulnerable Elders quality indicators were measured in 2 ways: (1) chart abstraction; and (2) staff responses to clinical vignettes of hypothetical residents at risk for falls. Recurrent fall rates (falls/resident/year) were measured. The proportion of the total variation in falls rates explained by the scores for each method (chart abstraction or vignette) was calculated using multilevel adjusted models. RESULTS: Chart and vignette measures of comorbidity management were moderately correlated (Pearson correlation coefficient 0.43), whereas other process measure categories had low or negative correlation between the 2 methods (psychoactive medication reduction 0.13, environmental modification -0.42, and exercise/rehabilitation -0.08). Measures of environmental modification and comorbidity management explained a moderate amount of the total variation in recurrent fall fates, vignettes (7%-10% variation explained) were superior to chart abstraction (2%-6% variation explained). Vignette responses from unlicensed staff (nurse aides and rehabilitation aides) explained more variance than registered nurses, licensed practical nurses, or other licensed staff in these categories. Process measures for psychoactive medication reduction and exercise/rehabilitation did not explain any of the variation in fall outcomes. Overall, vignette process measures explained 3.9% and chart abstraction measures explained 0% of the variation in fall outcomes. CONCLUSIONS: Clinical vignettes completed by nursing home staff had greater association with resident recurrent fall rates than traditional chart abstraction process measures. Published by Elsevier Inc.
OBJECTIVES: Validated process measures that correlate with patient outcomes are needed for research and quality improvement. DESIGN: Cross-sectional analysis within a cluster-randomized fall prevention study. SETTING: Nursing homes in North Carolina (n = 16). PARTICIPANTS: Nursing home staff (n = 541) and residents with 1 or more falls in 6 months (n = 597). MEASUREMENTS: Fall-prevention process measures in 4 categories derived from Assessing Care of Vulnerable Elders quality indicators were measured in 2 ways: (1) chart abstraction; and (2) staff responses to clinical vignettes of hypothetical residents at risk for falls. Recurrent fall rates (falls/resident/year) were measured. The proportion of the total variation in falls rates explained by the scores for each method (chart abstraction or vignette) was calculated using multilevel adjusted models. RESULTS: Chart and vignette measures of comorbidity management were moderately correlated (Pearson correlation coefficient 0.43), whereas other process measure categories had low or negative correlation between the 2 methods (psychoactive medication reduction 0.13, environmental modification -0.42, and exercise/rehabilitation -0.08). Measures of environmental modification and comorbidity management explained a moderate amount of the total variation in recurrent fall fates, vignettes (7%-10% variation explained) were superior to chart abstraction (2%-6% variation explained). Vignette responses from unlicensed staff (nurse aides and rehabilitation aides) explained more variance than registered nurses, licensed practical nurses, or other licensed staff in these categories. Process measures for psychoactive medication reduction and exercise/rehabilitation did not explain any of the variation in fall outcomes. Overall, vignette process measures explained 3.9% and chart abstraction measures explained 0% of the variation in fall outcomes. CONCLUSIONS: Clinical vignettes completed by nursing home staff had greater association with resident recurrent fall rates than traditional chart abstraction process measures. Published by Elsevier Inc.
Entities:
Keywords:
Nursing homes; clinical vignettes; fall prevention
Authors: Cathleen S Colón-Emeric; Deborah Lekan-Rutledge; Queen Utley-Smith; Natalie Ammarell; Donald Bailey; Mary L Piven; Kirsten Corazzini; Ruth A Anderson Journal: Health Care Manage Rev Date: 2006 Oct-Dec
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