Study of Infection Management and Palliative Care at End-of-Life (SIMP-EL)

临终感染管理和姑息治疗研究 (SIMP-EL)

• 批准号: 9306447
• 负责人: Patricia W. Stone
• 金额: $ 72.31万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9306447
• 关键词: American; Antibiotics; Area; Bacterial Infections; Caring; Characteristics; Clinical; Clostridium difficile; Compassion; Complement; Data; Data Set; Effectiveness of Interventions; Elderly; Family; Geriatric Nursing; Goals; Guidelines; Home Nursing Care; Hospitals; Human Resources; Individual; Infection; Infection Control; Life; Life Support Care; Link; Medicare; Nosocomial Infections; Nursing Homes; Palliative Care; Parents; Pharmaceutical Preparations; Policies; Prevention; Primary Health Care; Process; Quality of life; Research; Risk; Risk Factors; Scanning; Science; Structure; Surveys; Time; advanced disease; cost effectiveness; curative treatments; end of life; end of life care; hospice environment; improved; innovation; multi-drug resistant pathogen; palliation; programs

Excellence in palliative care is a priority in the nursing home (NH) setting, which provides care to many older residents with advanced illness at the end of life. Unfortunately, suboptimal palliative care is common. Infections are a frequent occurrence and management is challenging for many reasons. In our successful parent study we focused on infection control and management programs in NHs across the nation and found that annually 40% of all Medicare-certified NHs receive deficiency citations for inadequate infection control and less than half of NHs (46%) had written guidelines for antibiotic initiation. Antibiotics account for approximately 40% of all medications administered in NHs. Unfortunately, much of the use is inappropriate as antibiotics are often initiated in the absence of clinical evidence of a bacterial infection, and this misuse is a major risk factor for multidrug-resistant organisms and Clostridium difficile infections. Suspected infections are common reasons for elderly resident transfers to hospitals, and these are burdensome and often not clinically beneficial. For the majority of NH residents, the risks and suffering associated with antibiotic use and hospital transfer due to infection may outweigh the benefit. In addition, the infection control and management as well as the palliative care landscapes are changing in NHs with various regional and state level initiatives being implemented. It is likely that for some NHs these initiatives will promote resident-centered care that integrates infection management and palliative care while in others, NH personnel will be held to standards that favor burdensome curative treatments. In our competing renewal, we will use longitudinal Minimum Data Set data and Medicare files (i.e., approximately 1 million residents over years 2011 to 2017) to identify elderly NH residents and important resident level covariates (e.g., advanced illness), track antibiotic and hospice use, and track hospital transfers related to infections. We will complement and link these secondary datasets with environmental scans of state and regional activities as well as with data from a national survey of new NHs and our “core” NHs surveyed in 2014 as part of our parent study (we estimate that 1,500 NHs will respond). The survey will characterize implementation of current recommended structures and processes related to: 1) infection control and management, 2) palliative care, and 3) the integration of infection management and palliative care. Our specific aims are to: 1) Describe the integration of infection management and palliative care in NHs and the associated facility, state, and regional characteristics; 2) Examine factors associated with antibiotic use in elderly NH residents; and 3) Examine factors associated with hospital transfer due to infections among elderly NH residents. Understanding how best to improve the integration of infection management and palliative care to improve residents' quality of life is an under-studied area in need of rigorous research. Thus, this innovative study has the potential to make clinical and policy-relevant contributions by promoting resident-centered end- of-life care for millions of Americans living in NHs.

姑息治疗的卓越护理是护士住宅（NH）的优先事项，该设置为许多年龄较大的人提供护理 生命尽头患有晚期疾病的居民。不幸的是，次优姑息治疗很常见。 感染经常发生，由于许多原因，管理人员都具有挑战性。在我们的成功中 家长研究我们专注于全国NHS的感染控制和管理计划，发现 每年有40％的医疗保险认证的NHS都会因感染控制不足而受到缺乏引用 不到一半的NHS（46％）拥有抗生素起始指南。抗生素约为 在NHS中服用的所有药物中的40％。不幸的是，大部分用途是不合适的，因为抗生素是 通常在没有细菌感染的临床证据的情况下发起，这是主要的危险因素 用于耐多药的生物和艰难梭菌感染。怀疑感染是常见原因 对于老年居民转移到医院，这些都是繁重的，通常在临床上没有益处。 大多数NH居民，与抗生素使用和医院转移相关的风险和苦难 此外，感染控制和管理以及姑息 NHS的护理景观正在发生变化，并实施了各种区域和州一级倡议。这是 对于某些NHS，这些举措可能会促进以居民为中心的护理，以整合感染 在其他人中，管理和姑息治疗在其他方面，NH人员将被遵守有利于Burnensome的标准 治疗方法。在我们的竞争续约中，我们将使用纵向最小数据集数据和Medicare 档案（即2011年至2017年的大约100万居民）确定老年居民和 重要居民级别的协变量（例如，晚期疾病），田径抗生素和临终关怀以及跟踪医院 转移与感染有关。我们将补充并将这些次要数据集与环境联系起来 扫描国家和地区活动以及全国对新NHS调查的数据和我们的“核心” NHS于2014年作为我们的家长研究的一部分进行了调查（我们估计1,500 NHS将做出响应）。调查将 表征当前推荐结构和过程的实施：1）感染控制 2）姑息治疗，以及3）感染管理和姑息治疗的整合。我们的 具体目的是：1）描述NHS和NHS中感染管理和姑息治疗的整合 相关的设施，州和区域特征； 2）检查与使用抗生素有关的因素 NH居民老年； 3）检查由于基本感染引起的与医院转移相关的因素 NH居民。了解如何最好地改善感染管理和姑息治疗的整合 改善居民的生活质量是一个不足的领域，需要严格的研究。那，这种创新 研究有可能通过促进以居民为中心的最终 居住在NHS中的数百万美国人的生活护理。