This dissertation study examined hospital structures and processes associated with outcomes among hospitalized injured older adults (HIOA). The Minnick and Roberts Outcomes Production Model guided the design of a study that examined: 1) presence of geriatric-specific quality indicators in acute care hospitals that provide care to HIOAs; 2) associations among mutable organizational factors and adoption of quality indicators; and 3) the extent to which mutable organization factors, including geriatric-specific quality indicators explained variations in one adverse event (deep vein thrombosis [DVT] or pulmonary embolus [PE]) in HIOAs. Findings indicate that adoption of geriatric-specific quality indicators remains low. Factors associated with adoption of quality indicators included computerized support for clinical decision-making and comprehensive geriatric assessment. In a final regression model that represented four levels of hypothesized influence, after controlling for the influence of all other variables, the strongest adjusted associations with rates of DVT or PE were for comorbidities, and hospitals with simulated home and community rehabilitation environments. Despite ten years of efforts promoting adoption of geriatric-specific quality indicators, much progress remains to be made. The occurrence of DVT/PE in HIOAs remains a problem. Postoperative thromboembolism must be carefully considered as a quality indicator.
| Identifer | oai:union.ndltd.org:VANDERBILT/oai:VANDERBILTETD:etd-03232012-141305 |
| Date | 28 March 2012 |
| Creators | Maxwell, Cathy A. |
| Contributors | Lorraine C. Mion, Ann Minnick, Mary S. Dietrich, William F. Fallon |
| Publisher | VANDERBILT |
| Source Sets | Vanderbilt University Theses |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.vanderbilt.edu/available/etd-03232012-141305/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to Vanderbilt University or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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