The goal of the proposed research is to determine whether preventable adverse outcomes for the frail elderly population in long term care settings can be reduced by providing prospective computerized information alerting nursing and other staff to the likelihood of the problem occurring, and further providing resident specific risk factors likely to cause the adverse outcome so that preventive actions can be taken. Through the use of prospective clinical data, we hope to shift the focus from using Minimum Data Set (MDS) assessment data for investigating adverse outcomes after they occur, to one centering on the safety of individual residents before an adverse event occurs. We plan to test three specific outcomes of care that are directly related to patient safety and are known to be preventable adverse events -- falls, pressure ulcers and urinary tract infections (UTIs). These clinical outcomes represent major socio-economic problems in health care.
The specific aims of the project are to: (1) Support the use of clinical informatics by 'front line' staff that are in daily contact with residents. (2) Utilize predictive logistic regression models that identify the critical risk factors and calculate the likelihood of an adverse outcome occurring with a high degree of accuracy. (3) Encourage the day-to-day use of targeted clinical information through development of a web based application that will flag residents by predicted probability of the event occurring--high, moderate or low--and report the residents' risk factors based on the most recent assessment data so that interventions can be initiated before a negative outcome occurs, thereby improving the processes and outcomes of care. (4) Test the feasibility of accessing the web based application using 'bedside' electronic technology vs. hard copy reports. (S) Educate nursing staff about how to use the technology. (6) Conduct special training aimed at providing a basic understanding of the relevance and practical application of statistical and clinical information in avoiding errors and improving resident safety. (7) Measure statistically significant improvements in facility rates for the adverse outcomes following implementation of the information. (8) Identify 'best practices' in implementing the use of clinical informatics, as well as barriers to implementation. (9) Extend the collection and use of this data to the entire continuum of long term care providers.
