In this National Report of Nursing Home Quality Measures and Information Technology AHRQ will support an interdisciplinary research team who are already contributing to clinical research in long-term care settings. The PI is a doctorally-prepared RN and fellow in the American Academy of Nursing with over two decades of work in diverse projects, settings, and disciplines. The research strategy includes a three-wave, longitudinal, repeated measures study measuring Information Technology Sophistication (ITS) in a national sample of nursing homes (NH). Methods include an examination of the relationships between NH ITS and nationally- reported, publicly-available NH Quality Measures available through Nursing Home Compare and OSCAR over three consecutive years.
Specific aims are: 1) Describe the pattern of changes in overall ITS determined by changes in overall ITS over time and examine links between the changes in ITS and NH attributes, 2) Examine whether patterns of overall ITS changes are associated with the changes in Quality Measure scores over 3 years, and 3) Investigate relationships between specific types of ITS scores (Domains and Dimensions), NH attributes (Staffing, Facility, and Market Characteristics), and NH Quality Measures. ITS has been used to describe the diversity of IT and software used to support three domains of health care including Resident Care, Clinical Support, and Administrative Activities. Reported Quality Measures are risk-adjusted to account for variations in resident acuity so that care delivered in each facility can be compared. The project is highly innovative;national assessments of NH IT have not been linked previously with national NH Quality Measures. This study includes a survey of ITS in a nationally representative sample including 10% of NHs recruited from each state in the United States (N=1,570). We will incorporate a mixed model approach in our analysis including NH Quality Measures as the dependent, and Time and 9 different types of ITS as independent variables, respectively.
In Aim 1 we will assess NH ITS measured in three dimensions (Functional, Technological, and Integration) including types of IT used, extent of use of IT, and degree of external and internal IT integration, respectively. ITS will also be measured in three health care domains including Resident Care, Clinical Support, and Administrative Activities.
In Aim 2, we will examine associations between NH ITS, select NH attributes, and nationally reported Nursing Home Compare Quality Measures. We will characterize patterns of overall ITS over 3 years as increasing, stable, decreasing, or unstable (erratic). We will integrate classical econometric methods to correct for potential endogeneity of IT by using NH attributes including Staffing, Facility, and Market Characteristics as covariates in a mixed model approach including multivariate regression, dynamic panel model analysis, and an instrumental variable technique.

Public Health Relevance

This research is closely tied to AHRQ's health information technology and value portfolios. Nurses continue to bear great burdens for millions of patients in NHs;yet, issues persist with poor quality, variable performance of caregiving, and lack of implementation of proven care interventions. One new hope for quality improvement in NH care is the strategic management decision to implement IT to improve communication, clinical decision- making, and quality of care in these long term care organizations.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project (R01)
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Health Care Technology and Decision Science (HTDS)
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Burgess, Denise
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University of Missouri-Columbia
Schools of Nursing
United States
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