Infection Prevention in Home Health Care (InHOME)

家庭保健中的感染预防 (InHOME)

基本信息

批准号：
10365597
负责人：
Jingjing Shang
金额：
$ 89.56万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-21 至 2026-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10365597
关键词：
Adult Advocate Affect American COVID-19 COVID-19 disparity COVID-19 mortality COVID-19 pandemic COVID-19 risk Caregivers Caring Cessation of life Clinical Communicable Diseases Communities Complex Consensus Country Data Disadvantaged Elderly Emergency Situation Employee Environment Evolution Female Future Guidelines Health Care Sector Health Care Surveys Health Personnel Home Care Services Home Health Care Agencies Hospitalization Hospitals Individual Infection Infection Control Infection prevention Interview Knowledge Link Literature Measures Medicare Medicare claim Methods Modeling National Institute on Minority Health and Health Disparities Outcome Outcome Assessment Participant Patient Care Patient-Focused Outcomes Patients Persons Policies Population Procedures Process Public Health Readiness Recommendation Reduce health disparities Reporting Research Personnel Review Literature Risk Rural Community Source Surveys Time Training Vulnerable Populations Work beneficiary coronavirus disease design disadvantaged population dissemination strategy ethnic minority evidence base evidence based guidelines experience health care service health care settings health disparity high risk improved infection risk insight member minority health disparity mortality multidisciplinary multiple chronic conditions pandemic disease parent grant patient population personal protective equipment policy recommendation racial and ethnic rural underserved social health determinants socioeconomic disadvantage

项目摘要

Home healthcare (HHC) is the fastest growing healthcare sector and an important source of care for older Americans, including populations that historically have been vulnerable to health disparities. HHC patients are at high risk for infections. The COVID-19 pandemic has put a spotlight on infection prevention and control (IPC). However, our prior work indicates that HHC IPC capacity (i.e., IPC staffing, general IPC procedures, infection specific policies and employee IPC training policies) was sub-optimal and IPC preparedness (i.e., planning for and responding to an infectious disease crisis) was insufficient before the pandemic. Informed by our work in the parent grant “Infection Prevention in Home Health Care (InHOME, R01 NR016865)” and guided by Donabedian’s Quality Model and the Minority Health and Health Disparities Framework, in this competitive renewal we propose a 5-year, mixed methods study with 4 aims: 1) To describe changes in HHC IPC capacity and preparedness over time and its association with vulnerable populations; 2) To examine associations between HHC IPC capacity and HHC patient outcomes, overall and in vulnerable populations; 3) To examine the feasibility and potential barriers to implementing best practices in IPC capacity and preparedness through qualitative interviews with HHC personnel; and, 4) To develop evidence-based recommendations for improving HHC IPC capacity and preparedness to reduce the burden of COVID-19 and non-COVID-19 infections in HHC. In Aim 1, we will conduct two national surveys of HHC agencies (n = 600 per survey) in 2022 and 2024 and link them with our 2019 survey. We will assess the evolution of HHC IPC capacity and preparedness across the nation. In Aim 2, we will estimate the associations between HHC IPC capacity and HHC patient outcomes (infections, mortality) by linking our surveys with longitudinal HHC assessments (i.e., the Outcome and Assessment Information Set), Medicare claims and encounters data, and COVID-19 environment data. In Aim 3, we will conduct qualitative interviews with 60 purposively selected HHC personnel (i.e., 20 HHC agencies, 3 participants per agency) to discuss our findings, gather insights, and gain perspectives from those with firsthand experience implementing IPC policies and caring for patients. In Aim 4, we will conduct systematic literature review and synthesize our findings to inform a Delphi panel made up of key stakeholders (i.e., experts, leaders, advocates, patients and caregivers). We will develop clinical and policy recommendations refined and endorsed by our Delphi panel. This will result in data-driven, evidence-based recommendations that we will widely disseminate. Our multidisciplinary team is uniquely qualified to conduct this study. Leveraging our unique baseline data, our study will be the first comprehensive examination of IPC changes in HHC through the pandemic and its impact on patient outcomes. The results will provide recommendations to strengthen HHC agencies’ IPC capacity and preparedness to more effectively respond to the current and future infectious disease crises, protect the millions of Americans using HHC services every year, and reduce health disparities.

家庭医疗保健（HHC）是增长最快的医疗保健领域，是老年人的重要护理来源美国人，包括历史上容易受到健康差异的人群。 HHC患者是感染的高风险。 COVID-19大流行使预防感染和控制倍受关注（IPC）。但是，我们先前的工作表明HHC IPC容量（即IPC人员配备，一般IPC程序，感染特定政策和员工IPC培训政策）是最佳和IPC的准备（即在大流行之前，计划和应对传染病危机）是不够的。告知我们在父母赠款中的工作“预防家庭保健中的感染（Inhome，R01 NR016865）”，并指导在这个竞争激烈的续约我们提出了一项5年的混合方法研究，其目的是：1）描述HHC IPC容量的变化随着时间的流逝和与弱势群体的联系； 2）检查关联在HHC IPC容量和HHC患者结果之间，整体和脆弱人群之间； 3）检查通过IPC能力和准备的最佳实践的可行性和潜在障碍与HHC人员的定性访谈；以及，4）制定基于证据的建议来改善 HHC IPC的容量和准备降低HHC中COVID-19和非旋转19感染的燃烧的准备。在AIM 1中，我们将在2022年和2024年对HHC机构进行两项全国性调查（每次调查n = 600个调查）和Link 他们在我们的2019年调查中。我们将评估HHC IPC能力和准备的演变国家。在AIM 2中，我们将估计HHC IPC容量与HHC患者结果之间的关联（感染，死亡率）通过将我们的调查与纵向HHC评估联系起来（即结果和结果评估信息集），Medicare索赔和遇到数据以及COVID-19环境数据。目标 3，我们将对60个基本选择的HHC人员进行定性访谈（即20个HHC机构，3个每个代理商的参与者）讨论我们的发现，收集见解，并从与之第一手实施IPC政策和照顾患者的经验。在AIM 4中，我们将进行系统性文献综述并综合了我们的发现，以告知由主要利益相关者组成的Delphi小组（即专家，领导者，倡导者，患者和看护人）。我们将制定临床和政策建议由我们的Delphi面板精制并认可。这将导致数据驱动，基于证据的建议我们将广泛传播。我们的多学科团队具有独特的资格来进行这项研究。利用我们独特的基线数据，我们的研究将是对HHC中IPC变化的首次全面检查大流行及其对患者结局的影响。结果将为加强HHC提供建议代理商的IPC能力和准备，以更有效地应对当前和未来的感染力疾病危机，每年使用HHC服务来保护数百万美国人，并减少健康分布。