Cost-Effectiveness of Weight Loss Prevention in Nursing Homes: A Controlled Trial

疗养院预防减肥的成本效益：对照试验

• 批准号: 7941074
• 负责人: SANDRA F SIMMONS
• 金额: $ 48.02万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7941074
• 关键词: Cost; Effectiveness; Weight; Loss; Prevention

DESCRIPTION (provided by the PI): 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 (ONS), 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 or encouragement to promote consumption in daily NH care practice. The result is that nutritionally at-risk NH residents with ONS orders receive few additional daily calories from supplements. Recent evidence suggests that offering residents a choice among a variety of foods and fluids multiple times per day between meals coupled with assistance and encouragement to promote consumption is effective in increasing total daily caloric intake and promoting weight gain. However, based on the research to date, we do not know if residents' prefer other foods and fluids instead of supplements or if it is the consistency of delivery, adequacy of assistance and/or the availability of choice that represent the critical intervention components. We also do not know which intervention, traditional sip-feed supplements or choice, is more cost-effective in increasing daily caloric intake and promoting weight gain among NH residents. The cost-effectiveness component is key to further evaluation studies because supplements represent a significant financial cost to NH facilities. The proposed study will use a controlled, intervention design to determine the cost-effectiveness of ONS with an alternative nutrition intervention that offers residents a choice between supplements and other foods and fluids (i.e., snacks) between meals in a group of 250 residents across 4 NH sites. Residents with an order for supplementation will be included in this study and randomized into one of three groups: (1) usual care control; (2) oral liquid nutrition supplementation (ONS) intervention; or (3) choice intervention. The usual care control group will continue to receive standard NH care for supplement or snack delivery. Research staff will provide the same supplements used by the NH (group two) or a choice between supplements and other foods and fluids (group three) twice daily, five days per week, for 24 weeks and document the daily costs of intervention implementation when also providing a prompting protocol known to improve intake and enhance independence in eating. Based on extensive preliminary data, it is anticipated that both groups two and three will require significantly more staff time than usual care (group one). Thus, the labor costs of these interventions will be documented and compared to effectiveness measures. Effectiveness measures include the following resident outcomes: improvements in total daily caloric intake, weight, nutrition and hydration status and quality of life. These outcomes will be independently monitored for all three groups across 24-weeks by trained research staff using standardized, validated protocols.

描述（由PI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口服液体营养补充（ONS），尽管有限的控制证据表明补充剂在促进NH居民体重增加方面的功效有限。此外，研究表明，提供的补充剂与订单没有一致，居民几乎没有或没有任何员工的帮助或鼓励以促进日常护理惯例的消费。结果是，具有ONS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，并提供帮助和鼓励促进消费，这有效增加了每天的每日热量摄入量并促进体重增加。但是，根据迄今为止的研究，我们不知道居民是否更喜欢其他食物和液体而不是补充剂，或者它是否是交付的一致性，援助的充分性和/或选择代表关键干预组件的选择的可用性。我们也不知道哪种干预措施，传统的饮食补充剂或选择，在增加每日热量摄入量并促进NH居民体重增加方面更具成本效益。成本效益组件是进一步评估研究的关键，因为补充剂代表了NH设施的大量财务成本。拟议的研究将使用受控的干预设计来确定ONS的成本效益，并提供另一种营养干预措施，为居民提供补充剂与其他食品和液体（即小吃）之间的选择，在250名NH地点的250名居民中。该研究将包括补充命令的居民，并将其随机分为三组之一：（1）通常的护理控制； （2）口服液体营养补充（ONS）干预；或（3）选择干预。通常的护理对照组将继续获得标准的NH护理，以补充或零食。研究人员将提供与NH（第二组）使用的相同补品，或者在补充剂与其他食物和液体（第三组）之间进行选择，每周两次，每周五天，持续24周，并记录实施干预的日常成本，同时还提供了一种已知的及时协议，以改善摄入量和增强饮食的独立性。基于广泛的初步数据，预计两个组和第三组将比通常的护理（第一组）需要更多的员工时间。因此，将记录这些干预措施的人工成本，并将其与有效性措施进行比较。有效性措施包括以下居民成果：每日热量，体重，营养和水合作用的状态以及生活质量的改善。这些结果将通过训练有素的研究人员使用标准化的，经过验证的协议对24周的所有三个组进行独立监控。