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The quality of care in residential care facilities for the elderly.

机译：老年人住宅护理设施中的护理质量。

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摘要

This dissertation research examines Residential Care Facilities for the Elderly (RCFEs), often referred to as Assisted Living (AL), by considering policy and regulation, state licensing and monitoring systems and concerns regarding quality of care.;The first study examines the intended and unintended consequences of federal and state policy and regulation affecting the Residential Care/Assisted Living industry. An economic framework forms the basis for the examination of two broad effects of policy: the availability of assisted living facilities, and residents' ability to afford those services. The conceptual framework is described and progresses through a description of illustrative policy domains and intended and unintended consequences are discussed.;The second study proposes an adaptation of the Donabedian structure-process-outcome theory as a framework for designing and more effectively using the administrative data collected in the licensing and regulation of Residential Care/Assisted Living facilities. Structural components are represented by facility, staff and resident characteristics. Process components include the types of services available and safety and injury prevention. Possible outcome measures include deficiencies and complaints, changes of resident health status and quality indicators, and discharge and medical event data. Emphasis is on measures available in administrative records.;The last study was designed to evaluate the applicability of adapting the State of California administrative data regarding Residential Care Facilities for the Elderly (RCFFs) into a statewide system to monitor the quality of care provided. A randomly selected sample of 340 facilities was identified from the 3349 facilities licensed in Northern and Central California. Stratification of the sample was by facility capacity and State district office. Data collection consisted of a five-year retrospective review of the public files maintained across offices. A conceptual framework was developed to identify components thought to be indicative of quality of care. Such information was abstracted from the public files for data analyses. Collected data were analyzed using various descriptive statistics. Findings suggest that substantial limitations in current State data sources exist, as do concerns regarding quality of care. Suggestions are made to inform future researchers to further evaluate and improve the current monitoring system and develop a comprehensive, accessible information system.
机译：本论文研究通过考虑政策和法规，州许可和监控系统以及对护理质量的关注，研究了通常称为“辅助生活”（AL）的老年人住宿护理设施（RCFE）。联邦和州政策和法规对住宅护理/辅助生活行业产生意想不到的后果。经济框架构成了检验政策的两种主要效果的基础：辅助生活设施的可用性以及居民负担这些服务的能力。描述了概念框架，并通过描述说明性政策领域进行了讨论，并讨论了预期和非预期的结果。第二项研究提出了对Donabedian结构-过程-结果理论的改编，作为设计和更有效地使用行政数据的框架收录在“居家护理/辅助生活设施”的许可和法规中。结构组成由设施，员工和居民特征表示。过程组成部分包括可用的服务类型以及安全和预防伤害。可能的结果度量包括缺陷和投诉，居民健康状况和质量指标的变化以及出院和医疗事件数据。重点在于行政记录中可采取的措施。；上一研究旨在评估将加利福尼亚州老年人护理设施（RCFF）的行政数据改编为全州系统以监控所提供护理质量的适用性。从加利福尼亚北部和中部许可的3349家工厂中随机选择了340家工厂。样本的分层是按设施容量和州民政部门来进行的。数据收集包括对各局维护的公共档案进行的五年回顾性审查。开发了概念框架以识别被认为指示护理质量的组件。这些信息是从公共文件中提取的，用于数据分析。使用各种描述性统计数据分析收集的数据。调查结果表明，当前州数据来源存在重大局限性，对医疗质量的担忧也存在。提出建议，告知未来的研究人员进一步评估和改进当前的监视系统，并开发一个全面的，可访问的信息系统。

著录项

  • 作者

    Flores, Cristina.;

  • 作者单位

    University of California, San Francisco.;

  • 授予单位 University of California, San Francisco.;
  • 学科 Gerontology.;Health Sciences Nursing.
  • 学位 Ph.D.
  • 年度 2007
  • 页码 150 p.
  • 总页数 150
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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