A Multifaceted Intervention to Implement Guidelines Did Not Affect Hospitalization Rates for Nursing Home-Acquired Pneumonia
A Multifaceted Intervention to Implement Guidelines Did Not Affect Hospitalization Rates for Nursing Home-Acquired Pneumonia
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DOI：
10.1016/j.jamda.2010.03.011
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发表时间：
2011-09-01
影响因子：
7.6
通讯作者：
McNulty, Monica C.
中科院分区：
文献类型：
--
作者：
Hutt, Evelyn;Ruscin, J. Mark;McNulty, Monica C.
目的：确定一个全面的方法来实施全国共识指南的护理家庭获得性肺炎（NHAP）是否影响住院率。设计：准实验，混合方法，多方面，非盲干预试验。在2004年10月至2007年4月的3个流感季节期间，在堪萨斯和密苏里州进行了8例研究。参与者：具有2种或2种以上全身性下呼吸道感染（LRTI）体征和症状的居民; NH工作人员和医生符合条件。多方面的，包括学术详细的临床医生，在设施内的护士更换agent，财政奖励，和nursingeducation.Measurements：主题的NH病历进行了审查居民的特点，疾病的严重程度，和护理过程。双变量分析比较了干预和对照NH之间和时间段内生命体征稳定和不稳定受试者的住院率。定性访谈进行了分析，使用内容coding.Results：住院率稳定的居民在两个NH组在整个研究中保持较低。在基线期或干预期，干预NH中很少有危重受试者住院。在对照NH中，8.7%的生命体征不稳定的受试者在基线期间住院，干预第2年为33%，但差异无统计学意义（P = 0.10）。与护理人员和领导层的访谈证实，有显着的压力，使能，避免住院治疗的急性infections. Conclusions：世俗的压力，以避免住院治疗和挑战，达到NH医生通过学术细节可能是负责缺乏干预的影响住院率为危重NH居民。（《美国医学发展杂志》，2011年; 12：499 - 507）
Objective: Determine whether a comprehensive approach to implementing national consensus guidelines for nursing home acquired pneumonia (NHAP) affected hospitalization rates.Design: Quasi-experimental, mixed-methods, multifaceted, unblinded intervention trial.Setting: Sixteen nursing homes (NHs) from 1 corporation: 8 in metropolitan Denver, CO; 8 in Kansas and Missouri during 3 influenza seasons, October to April 2004 to 2007.Participants: Residents with 2 or more signs and symptoms of systemic lower respiratory tract infection (LRTI); NH staff and physicians were eligible.Intervention: Multifaceted, including academic detailing to clinicians, within-facility nurse change agent, financial incentives, and nursing education.Measurements: Subjects' NH medical records were reviewed for resident characteristics, disease severity, and care processes. Bivariate analysis compared hospitalization rates for subjects with stable and unstable vital signs between intervention and control NHs and time periods. Qualitative interviews were analyzed using content coding.Results: Hospitalization rates for stable residents in both NH groups remained low throughout the study. Few critically ill subjects in the intervention NHs were hospitalized in either the baseline or intervention period. In control NHs, 8.7% of subjects with unstable vital signs were hospitalized during the baseline and 33% in intervention year 2, but the difference was not statistically significant (P = .10). Interviews with nursing staff and leadership confirmed there were significant pressures for, and enablers of, avoiding hospitalization for treatment of acute infections.Conclusions: Secular pressures to avoid hospitalization and the challenges of reaching NH physicians via academic detailing are likely responsible for the lack of intervention effect on hospitalization rates for critically ill NH residents. (J Am Med Dir Assoc 2011; 12: 499-507)