Infection Prevention in Home Health Care (InHOME)

家庭医疗保健（HHC）是增长最快的医疗保健部门，也是老年人护理的重要来源 美国人，包括历史上容易受到健康差异影响的人群。HHC患者 感染的风险很高COVID-19大流行使感染预防和控制成为焦点 （IPC）。然而，我们先前的工作表明，HHC IPC容量（即，IPC人员配备，IPC一般程序， 感染特异性政策和员工IPC培训政策）是次优的，IPC准备（即， 传染病危机的规划和应对）在大流行病之前是不够的。通知 我们的工作在家长赠款“感染预防家庭保健（在居家，R 01 NR 016865）”和指导 通过Donabedian的质量模型和少数民族健康和健康差异框架，在这个竞争激烈的 更新我们提出了一项为期5年的混合方法研究，具有4个目标：1）描述HHC IPC容量的变化 （2）审查与脆弱群体之间的联系; HHC IPC能力和HHC患者结局之间的关系，总体和弱势人群; 3）检查 在IPC能力和准备方面实施最佳做法的可行性和潜在障碍， 与HHC人员进行定性访谈;以及，4）制定基于证据的建议，以改善 HHC IPC的能力和准备，以减少HHC的COVID-19和非COVID-19感染的负担。 在目标1中，我们将在2022年和2024年对HHC机构进行两次全国性调查（每次调查n = 600），并将 我们的2019年调查。我们将评估HHC IPC能力和准备的演变， 民族在目标2中，我们将评估HHC IPC容量与HHC患者结局之间的相关性 （感染，死亡率）通过将我们的调查与纵向HHC评估（即，的成果和 评估信息集）、医疗保险索赔和遭遇数据以及COVID-19环境数据。在Aim中 3、我们将对60名有目的地选择的HHC人员进行定性访谈（即，20个卫生和人道主义事务部机构，3个 每个机构的参与者）讨论我们的调查结果，收集见解，并从那些 实施IPC政策和照顾患者的第一手经验。在目标4中，我们将进行系统的 文献回顾和综合我们的发现，以告知由关键利益相关者组成的德尔菲小组（即， 专家、领导者、倡导者、患者和护理人员）。我们将制定临床和政策建议 由我们的德尔菲专家组进行了完善和认可。这将产生数据驱动的、基于证据的建议 我们将广泛传播。我们的多学科团队是唯一有资格进行这项研究。利用 我们独特的基线数据，我们的研究将是第一次全面检查IPC的变化， 大流行及其对患者预后的影响。结果将提供建议，以加强HHC 机构的IPC能力和准备，以更有效地应对当前和未来的传染病 疾病危机，保护每年使用HHC服务的数百万美国人，并减少健康差距。

Home healthcare (HHC) is the fastest growing healthcare sector and an important source of care for older Americans, including populations that historically have been vulnerable to health disparities. HHC patients are at high risk for infections. The COVID-19 pandemic has put a spotlight on infection prevention and control (IPC). However, our prior work indicates that HHC IPC capacity (i.e., IPC staffing, general IPC procedures, infection specific policies and employee IPC training policies) was sub-optimal and IPC preparedness (i.e., planning for and responding to an infectious disease crisis) was insufficient before the pandemic. Informed by our work in the parent grant “Infection Prevention in Home Health Care (InHOME, R01 NR016865)” and guided by Donabedian’s Quality Model and the Minority Health and Health Disparities Framework, in this competitive renewal we propose a 5-year, mixed methods study with 4 aims: 1) To describe changes in HHC IPC capacity and preparedness over time and its association with vulnerable populations; 2) To examine associations between HHC IPC capacity and HHC patient outcomes, overall and in vulnerable populations; 3) To examine the feasibility and potential barriers to implementing best practices in IPC capacity and preparedness through qualitative interviews with HHC personnel; and, 4) To develop evidence-based recommendations for improving HHC IPC capacity and preparedness to reduce the burden of COVID-19 and non-COVID-19 infections in HHC. In Aim 1, we will conduct two national surveys of HHC agencies (n = 600 per survey) in 2022 and 2024 and link them with our 2019 survey. We will assess the evolution of HHC IPC capacity and preparedness across the nation. In Aim 2, we will estimate the associations between HHC IPC capacity and HHC patient outcomes (infections, mortality) by linking our surveys with longitudinal HHC assessments (i.e., the Outcome and Assessment Information Set), Medicare claims and encounters data, and COVID-19 environment data. In Aim 3, we will conduct qualitative interviews with 60 purposively selected HHC personnel (i.e., 20 HHC agencies, 3 participants per agency) to discuss our findings, gather insights, and gain perspectives from those with firsthand experience implementing IPC policies and caring for patients. In Aim 4, we will conduct systematic literature review and synthesize our findings to inform a Delphi panel made up of key stakeholders (i.e., experts, leaders, advocates, patients and caregivers). We will develop clinical and policy recommendations refined and endorsed by our Delphi panel. This will result in data-driven, evidence-based recommendations that we will widely disseminate. Our multidisciplinary team is uniquely qualified to conduct this study. Leveraging our unique baseline data, our study will be the first comprehensive examination of IPC changes in HHC through the pandemic and its impact on patient outcomes. The results will provide recommendations to strengthen HHC agencies’ IPC capacity and preparedness to more effectively respond to the current and future infectious disease crises, protect the millions of Americans using HHC services every year, and reduce health disparities.