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) 是美国最大且增长最快的医疗保健行业之一。 患者面临医疗保健相关感染 (HAI) 的风险； 由于获得医疗资源的机会有限以及环境因素的存在，可能更容易受到感染 只有两项研究调查了 HHC 患者的社会经济状况。 （SES）和感染风险，并且它们受到数据年龄、当地调查范围和未能衡量的限制 HHC 患者居住社区的社会经济构成复杂，感染预防和预防。 由于 HHC 为弱势群体服务，因此 HHC 中的控制 (IPC) 在 COVID-19 大流行期间尤为突出。 然而，我们发现 IPC 在 HHC 中并不是最理想的，并且 HHC 民间报告称，住房条件差和 患者/非正式护理人员难以遵守推荐的做法，这对 HHC 中的 IPC 基于我们之前的研究并以社会生态模型为指导，我们提出了 5- 年，多地点、混合方法研究，旨在解决以下目标：1）审查社会经济 在 COVID-19 之前和期间，HHC 患者之间的感染事件（包括 COVID-19）存在差异 2) 描述 HHC 患者（或非正式的）与 IPC 相关的知识、态度和实践 3）从HHC患者角度探索IPC实践 （或非正式护理人员）和 HHC 提供者；以及 4) 开发并试点测试多模式干预措施以改进 HHC 患者（或非正式护理人员）的 IPC 知识和实践 我们将合并多个国籍。 2019-2020 年数据集，包含最新的面积剥夺指数 (ADI) 文件，这是一种多维 SES 衡量指标 我们将研究 COVID-19 大流行之前和期间与感染相关的健康差异。 研究 HHC 中四种常见 HAI（呼吸系统、 HHC 入院后 2 天发生的尿路伤口（与静脉导管相关）以及 COVID-19 感染高风险和极高感染风险的患者和/或其非正式护理人员 (n = 250）来自两个 HHC 机构，为广大地理区域中具有不同社会经济背景的患者提供服务 将调查各地区，了解其 IPC 相关知识、态度、做法和环境风险 对患者（或非正式护理人员）和 HHC 提供者进行创新的二元访谈分析。 访谈（40 对），我们将更好地了解患者/护理人员对 IPC 的障碍，并探讨如何最好地 加强患者（或非正式护理人员）与 HHC 提供者的互动并改善家庭 IPC 实践。 我们将对目标 1-3 的结果进行三角测量，以制定多模式干预措施，以提高 IPC 知识 并在 HHC 患者和非正式护理人员中进行实践，并在所有地区的 30 名患者中进行试点测试 该项目的研究结果将由多学科团队进行。 指导 HHC 环境中未来的临床 IPC 实践。