The use of physical restraints with frail older adults is associated with increased risk for serious injuries and accidental death, as well as contributing to negative patient outcomes. Yet, the use of physical restraints with frail older adults in hospitals persists. This study examines the impact of hospital organizational context and nurse staffing on restraint use and associated patient outcomes. Data on restraint use for hip fracture patients in hospital will be merged with American Hospital Association Annual Hospital Survey data on hospital characteristics and nurse staffing and extensive organizational data from surveys collected in several NINR-funded studies by Penn's Center for Health Outcomes and Policy Research. It is hypothesized that hospital nurse staffing and organization affect the rate of physical restraint use, and that such use is associated with poorer outcomes at discharge. My research to date has focused on patient characteristics associated with physical restraint. In order to achieve my long term goal to be an independent investigator in outcomes research regarding care of frail older adults. I need advanced training and mentoring in the requisite methodologies and analytic techniques used in the emerging field of outcomes research. With targeted training and conduct of this proposed study, I will gain a new research skill set in the design and analysis required to investigate the organization of nursing, manage large date sets, and analyze interactive effects of multiple variables on outcomes employing such methods as hierarchical linear modeling, censoring, and multiple imputation techniques. This proposed study is consistent with my goals to expand my clinical research into a new field of inquiry, nursing outcomes research, in which I have had no previous training or experience. My goal for this research career award are to: 1) gain a new research skill set in outcomes research, 2) extend my research program by examining the effects of hospital factors on physical restraint and other outcomes, 3) publish findings in peer- reviewed journals, 4) develop a proposal for extramural funding extending the scope of the study proposed here, and 5) establish interdisciplinary/collaborative relationships with experts in the field of outcomes research.
