Disparities in Infection in Home Health and Patients/Caregivers' Perceptions (Dis-Infection in HHC)

家庭健康中的感染差异和患者/护理人员的看法（HHC 中的消毒）

• 批准号: 10480860
• 负责人: Jingjing Shang
• 金额: $ 49.55万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-03 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10480860
• 关键词: Disparities; Infection; Home; Health; Patients

Home health care (HHC) is one of the largest and most rapidly growing health care sectors in the nation. HHC patients are at risk for healthcare associated infections (HAIs); socioeconomically disadvantaged HHC patients may be more prone to infections due to limited access to healthcare resources and presence of environmental hazards that increase infection risk. Only two studies have examined HHC patients' socioeconomic status (SES) and infection risk, and they are limited by the age of data, local scope of inquiry, and failure to measure the complex socio-economic composition of communities where HHC patients reside. Infection prevention and control (IPC) in HHC is prominent during the COVID-19 pandemic as HHC serves a vulnerable population. However, we found IPC is suboptimal in HHC and HHC clinicians reported that poor housing conditions and difficulties with patient/informal caregiver compliance with recommended practices pose specific challenges to IPC in HHC. Building upon our previous studies and guided by the Social-Ecological Model, we propose a 5- year, multi-site, mixed methods research study to address following aims: 1) examine socio-economic disparities in infection events, including COVID-19, among HHC patients before and during the COVID-19 pandemic; 2) describe IPC-related knowledge, attitudes, and practices among HHC patients (or informal caregivers) and examine associated factors; 3) explore IPC practices from the perspectives of HHC patients (or informal caregivers) and HHC provider; and 4) develop and pilot test a multi-modal intervention to improve knowledge and practice of IPC in HHC patients (or informal caregivers). We will merge multiple national datasets from 2019-2020 with the latest Area Deprivation Index (ADI) file, a multidimensional SES measure of neighborhoods, to study infection-related health disparities before and during the COVID-19 pandemic. We will study hospital transfers or emergency care visits due to four commonly reported HAIs in HHC (respiratory, urinary tract, wound and intravenous catheter-related) that occur 2 days after HHC admission as well as COVID-19 infections. Patients with high and very high risk of infection and/or their informal caregivers (n = 250) from two HHC agencies serving patients with diverse socioeconomic backgrounds in large geographic areas will be surveyed to understand their IPC-related knowledge, attitudes, practices and environmental risk factors. Using innovative dyadic interview analysis of both patient (or informal caregiver) and HHC provider interviews (40 pairs), we will better understand patient/caregivers’ barriers to IPC and explore how best to enhance patient (or informal caregiver)-HHC provider interactions and improve IPC practices at home. Finally, we will triangulate the results from Aims 1-3 to develop a multimodal intervention to improve IPC knowledge and practices among HHC patients and informal caregivers, and pilot test it among 30 patients across all racial/ethnic and SES backgrounds. Conducted by a multi-disciplinary team, findings of this project will be used to guide future clinical IPC practices in HHC settings.

家庭医疗保健（HHC）是美国最大，最快的医疗保健领域之一。 HHC 患者有医疗保健相关感染的风险（HAIS）；社会经济上处于不利地位的HHC患者 由于获得医疗资源和环境的存在，可能更容易感染感染 增加感染风险的危害。只有两项研究检查了HHC患者的社会经济状况 （SES）和感染风险，并且受数据的年龄，当地查询范围和未能衡量的限制 HHC患者居住的社区的复杂社会经济组成。预防感染和 HHC期间，HHC中的控制（IPC）是HHC为脆弱人群服务的。 但是，我们发现IPC在HHC中是次优的，HHC临床医生报告说，住房状况不佳和 患者/非正式护理人员遵守建议做法的困难构成了具体挑战 HHC中的IPC。在我们以前的研究的基础上，并以社会生态模型为指导，我们提出了一个5- 年，多站点，混合方法研究研究以解决以下目的：1）检查社会经济 在Covid-19之前和期间，HHC患者之间的感染事件的差异，包括COVID-19 大流行; 2）描述HHC患者中与IPC相关的知识，吸引力和实践（或非正式 护理人员）并检查相关因素； 3）从HHC患者的角度探索IPC实践 （或非正式护理人员）和HHC提供者； 4）开发和试点测试多模式干预以改进 IPC在HHC患者（或非正式护理人员）中的知识和实践。我们将合并多个国家 2019 - 2020年的数据集带有最新的区域剥夺指数（ADI）文件，这是多维SES测量 社区，研究在19009年大流行之前和期间与感染相关的健康差异。我们将 研究医院的转学或急诊就诊，原因是HHC中有四次通常报告的HAI（呼吸， HHC入院后2天发生的尿路，伤口和静脉导管相关） Covid-19感染。感染风险高且高的患者和/或其非正式护理人员（n = 250）来自两个HHC机构，为大型地理的潜水员社会经济背景患者提供服务 将对领域进行调查，以了解其与IPC相关的知识，吸引力，实践和环境风险 因素。使用患者（或非正式护理人员）和HHC提供者的创新二元访谈分析 访谈（40双），我们将更好地了解患者/护理人员对IPC的障碍，并探索如何最好的 增强患者（或非正式护理人员）-HHC提供者的互动并改善在家中的IPC实践。最后， 我们将对目标1-3的结果进行三角调节，以开发多模式干预以改善IPC知识 以及HHC患者和非正式护理人员的实践，并在30名患者中对其进行试验。 种族/种族和SES背景。由多学科团队进行的，将使用该项目的发现 指导HHC设置中未来的临床IPC实践。