Cost-Effectiveness of Two Nutrition Interventions in Long-Term Care

长期护理中两种营养干预措施的成本效益

基本信息

批准号：
8705331
负责人：
SANDRA F SIMMONS
金额：
$ 42.16万
依托单位：
VANDERBILT UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-08-15 至 2016-04-29
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8705331
关键词：
Address Body Weight Body Weight decreased Calories Caring Cessation of life Clinical Consumption Control Groups Coupled Data Dehydration Dietary Intervention Eating Effectiveness of Interventions Energy Intake Ensure Financial cost Food Food Services Guidelines Home Nursing Care Hospitalization Indigenous Intake Intervention Intervention Trial Investments Lead Light Liquid substance Long-Term Care Measures Monitor Nurses&apos Aides Nursing Homes Nursing Staff Nutritional Support Oral Outcome Phase Populations at Risk Prevention Protocols documentation Quality of life Randomized Regulation Relative (related person)Research Research Training Resources Risk Site Supplementation Time Training Translational Research Translations Weight Weight Gain care delivery comparative cost cost effective cost effectiveness depressive symptoms design effectiveness measure experience feeding group intervention improved nursing home length of stay nutrition research study satisfaction therapy design translational study treatment as usual wasting weight maintenance

项目摘要

DESCRIPTION (provided by applicant): Inadequate food and fluid intake is a common problem among nursing home (NH) residents and one that can lead to under-nutrition, dehydration, weight loss, hospitalization, and even death. The most common nutrition intervention for at-risk NH residents is oral liquid nutrition supplementation, although, there is limited controlled evidence of the efficacy of supplements in promoting weight gain in NH residents. Moreover, studies show that supplements are not provided consistent with orders and residents receive little to no staff assistance to promote consumption in daily NH care practice. The result is that nutritionally at-risk NH residents with supplement orders receive few additional daily calories from supplements. Recent evidence strongly suggests that offering residents a choice among a variety of foods and fluids multiple times per day between meals coupled with assistance is effective in increasing daily caloric intake and promoting weight gain. However, the provision of the between-meal choice intervention requires significantly more staff time relative to the amount of time NH staff currently spend on between-meal nutritional care provision. A new federal regulation allows NHs to train non-nursing staff to provide feeding assistance care. Preliminary research has demonstrated that non-nursing staff trained as "feeding assistants" provide mealtime feeding assistance care that is comparable to or better than their indigenous nurse aide counterparts. Moreover, a recent demonstration project showed that these staff can be used to effectively augment nurse aide staff for mealtime feeding assistance care provision in daily care practice. The proposed translational study will utilize the federal regulation to train non-nursing staff for between-meal nutritional care delivery. Specifically, the proposed study will use a controlled, intervention design to determine the cost-effectiveness of the between-meal choice intervention relative to a usual care control group in a group of 200 residents across 4 NH sites. Residents with an order for caloric supplementation will be included in this study and randomized into either a usual care control group or a choice intervention group (100 residents per group). The usual care control group will continue to receive standard NH care for supplement or snack delivery between meals, as provided by indigenous nurse aide staff. Non-nursing staff trained as "feeding assistants" will offer residents in the intervention group a choice between supplements and other snack foods and fluids twice daily, five days per week, for 24 weeks while also providing a standardized prompting protocol to enhance intake and independence in eating. Research staff will independently document the costs of intervention implementation and compare these costs to effectiveness measures which include improvements in caloric intake, weight and quality of life. These outcomes will be independently monitored for both groups across 24 study weeks by trained research staff using standardized, validated protocols. This translational research effort will provide critical information to improve care practices in nursing homes for nutritionally at risk residents.

描述（由申请人提供）：食物和液体摄入不足是疗养院（NH）居民的常见问题，并且可能导致营养不足，脱水，体重减轻，住院甚至死亡。高危NH居民最常见的营养干预是补充口服液体营养，尽管有限的受控证据证明补充剂在促进NH居民体重增加方面的疗效。此外，研究表明，提供的补充剂与订单没有一致，居民几乎没有受到员工的帮助来促进NH护理惯例的消费。结果是，具有补充订单的营养高危NH居民从补充剂中获得的每日卡路里很少。最近的证据强烈表明，在两餐之间，每天多次为居民提供多次食物和液体的选择，并有效地增加了每日热量摄入量并促进体重增加。但是，相对于当前NH员工在美食间营养护理提供的时间，提供美食之间的选择干预措施需要更多的员工时间。一项新的联邦法规允许NHS培训非武装人员提供喂养援助护理。初步研究表明，接受“喂食助手”培训的非武装人员提供饮食时间喂食辅助护理，与其土著护士助手助手相比或更好。此外，最近的一个示范项目表明，这些员工可用于有效地扩大护士助手的饮食时间喂食时间，以便在日常护理实践中提供辅助护理。拟议的翻译研究将利用联邦法规来培训非武装人员进行营养之间的医疗服务。具体而言，拟议的研究将使用受控的干预设计来确定相对于在4个NH地点的200名居民组中，相对于常规护理对照组的美食间干预措施的成本效益。补充热量的居民将包括在本研究中，并随机分为通常的护理对照组或选择干预组（每组100个居民）。正常护理对照组将继续获得标准的NH护理，以提供由土著护士助手工作人员提供的餐点之间的补充或零食。接受“喂养助手”培训的非努力人员将为干预组的居民提供补充剂与其他零食食品和液体之间的选择，每周五天，每周五天，持续24周，同时还提供了标准化的提示方案，以增强摄入量和饮食独立性。研究人员将独立记录实施干预的成本，并将这些成本与有效措施进行比较，包括改善热量摄入量，体重和生活质量。这些结果将通过经过标准化的，经过验证的协议在经过培训的研究人员中对两组的两组进行独立监测。这项翻译研究工作将提供关键信息，以改善养老院的护理习惯，以供危险居民营养。