Prevention of Nosocomial Infections and Cost Effectiveness in Nursing Homes

疗养院院内感染的预防和成本效益

• 批准号: 8345233
• 负责人: Patricia W. Stone
• 金额: $ 67.51万
• 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 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8345233
• 关键词: Accounting; Acute; Address; American; Beds; Caring; Centers for Disease Control and Prevention (U.S.); Certification; Cessation of life; Characteristics; Communities; Confounding Factors (Epidemiology); Data; Data Reporting; Data Set; Effectiveness; Elderly; Frail Elderly; Future; Guidelines; Health; Healthcare; Healthcare Systems; Home environment; Hospitals; Human; Human Resources; Incidence; Infection; Infection Control; Infection prevention; Inpatients; Intensive Care Units; Interview; Learning; Life; Link; Mandatory Reporting; Medicare; Methods; Modeling; Morbidity - disease rate; Multi-Drug Resistance; Nosocomial Infections; Nursing Homes; Nursing Staff; Organism; Outpatients; Ownership; Patients; Phase; Pneumonia; Policy Maker; Population; Prevention; Probability; Procedures; Process; Qualifying; Reporting; Research; Research Methodology; Review Literature; Safety; Sampling; Seminal; Sepsis; Services; Structure; Surveys; United States Dept. of Health and Human Services; Urinary tract infection; Vulnerable Populations; Work; Wound Infection; base; comparative effectiveness; cost; cost effectiveness; design; disorder prevention; high risk; improved; innovation; interest; meetings; mortality; prevent; response; statistics; systematic review

DESCRIPTION (provided by applicant): Approximately 1.6 million Americans live in the nation's 16,000 nursing homes (NHs) and the "frail elderly" account for 90% of the residents. This population is expected to increase dramatically and become more diverse in the coming years. It is reported that between 1.6 and 3.8 million infections occur each year in U.S. NHs. Healthcare associated infections (HAI) are leading causes of morbidity and mortality among residents and this vulnerable population is considered high risk for infection and colonization with multi-drug resistant organisms (MDRO). We have found that 15% of U.S. NHs receives deficiency citations for infection control each year indicating a clear need to focus on prevention in these settings. In NHs there is little research documenting the efficacy of infection control related structures or processes in preventing HAI. Some states have regulated mandatory reporting of HAI in NHs and other states have implemented statewide learning collaborative; however, the effectiveness of these initiatives is not known. Research is clearly needed to understand best practices related to HAI prevention and the value of infection control in this setting. Building upon our previous work in acute care and partnering with experts conducting research in NHs, we propose a 4- year, mixed-method, comparative effectiveness study that will address these gaps. Our aims are: 1) Describe the incidence of HAI (pneumonia, sepsis, urinary tract infections, wound infections and MDRO infections/colonization) in NHs across the nation and associated state level characteristics (e.g., mandatory reporting and statewide collaborative), facility level characteristics (e.g., ownership, bed size and nurse staffing) and resident care processes (e.g., isolation); 2) Identify NHs that have persistently high and low HAI rates and the relationship between the HAI rates, state and facility level characteristics and resident care processes; 3) Use a descriptive exploratory approach to describe the phenomenon of infection control in NHs; 4) Determine the comparative effectiveness of current infection control structures and processes in preventing HAIs in elderly residents; and 5) Determine the cost-effectiveness of efficacious infection control processes in NHs. The analytic strategy for Aim 3 includes well-developed qualitative procedures that maximize completeness and truthfulness of the data. The analytic strategies for Aims 1, 2, 4 and 5 include state of the art multivariate econometric methods designed to minimize potential bias and address clustering of data. Our interdisciplinary team is uniquely qualified to conduct this study. Results will inform bedside clinicians and policy makers across the nation on how to best eliminate HAIs in NHs and inform future guidelines. PUBLIC HEALTH RELEVANCE: Approximately 1.6 million Americans live in the nation's 16,000 nursing homes (NHs) and the "frail elderly" account for 90% of the residents. It is reported that between 1.6 and 3.8 million infections occur each year in U.S. NHs and 15% of these NHs receive deficiency citations for infection control each year indicating a clear need to focus on prevention in these settings. This study will provide better understanding of what NHs need to do to implement and sustain research-based innovations to prevent infections and improve the health and safety of their frail elderly residents.

描述（由申请人提供）：大约有160万美国人居住在该国的16,000家疗养院（NHS）和“脆弱的老年人”中占90％的居民。预计该人群将在未来几年急剧增加，并变得更加多样化。据报道，美国NHS每年发生1.6至380万次感染。医疗保健相关感染（HAI）是居民发病率和死亡率的主要原因，而这种脆弱的人群被认为是具有多药耐药生物体（MDRO）的高风险和殖民化的高风险。我们发现，每年有15％的美国NHS收到缺乏引用感染控制的缺陷，表明明显需要专注于预防 在这些设置中。在NHS中，很少有研究记录了与感染控制相关结构或过程中预防HAI的疗效。一些州已监管NHS和其他州对HAI的强制性报告，已实施全州学习的合作。但是，这些举措的有效性尚不清楚。显然需要进行研究，以了解与HAI预防有关的最佳实践以及在这种情况下感染控制的价值。在我们先前在急诊护理方面的工作并与在NHS进行研究的专家合作的基础上，我们提出了一项为期4年的混合方法，比较有效性研究，以解决这些差距。我们的目的是：1）描述全国NHS中HAI（肺炎，脓毒症，尿路感染，伤口感染和MDRO感染/殖民化）的发生率以及州级的特征（例如，强制性报告和州层的报告和州范围的协作），设施级别的特征（例如，所有权，层次）（例如，床位）（例如，床位）（例如，床位）。 2）确定HAI率持续高和低的NHS以及HAI率，州和设施水平特征与居民护理过程之间的关系； 3）使用描述性探索方法来描述NHS感染控制现象； 4）确定当前感染控制结构和预防老年居民HAI的过程的比较有效性； 5）确定NHS有效感染控制过程的成本效益。 AIM 3的分析策略包括发达的定性程序，可最大程度地提高数据的完整性和真实性。目标1、2、4和5的分析策略包括最先进的多元计量经济学方法，旨在最大程度地减少潜在的偏见并解决数据的聚类。我们的跨学科团队具有独特的资格来进行这项研究。结果 将为全国各地的床旁临床医生和政策制定者提供信息，以了解如何最好地消除NHS中的HAI并为未来的指南提供信息。 公共卫生相关性：大约有160万美国人居住在该国的16,000家疗养院（NHS）和“脆弱的老年人”中占90％的居民。据报道，每年在美国NHS中发生1.6至380万感染，其中15％的NHS每年接受缺乏引用感染控制，这表明在这些情况下明显需要专注于预防。这项研究将更好地了解NHS在实施和维持基于研究的创新中需要做什么，以防止感染并改善其脆弱的老年居民的健康和安全。