Developing and Testing an Evidence-Based Toolkit for Nursing Home Care of Residents with Obesity

项目摘要 在这里提出的研究中，我们将评估护理之家（NHs）使用的策略，以防止不良反应的发生。 影响肥胖居民的安全事件，并开发一个基于证据的工具包，以帮助NHS适应 增加了肥胖居民的护理挑战。美国140万NH居民中的30%。 每天，居民肥胖使得提供安全，高质量的护理变得更加困难， 在美国超过15，000个NHS中，肥胖居民需要更多的护理， 监护协助日常活动，如移动性，移动和皮肤评估。居民与 肥胖是不良安全事件的高风险，如可预防的压疮、感染、福尔斯， 再入院为了科普这些挑战，NHS可能会适应肥胖居民的需求， 通过组织适应策略预防不良安全事件，该策略利用以下组合： 更多的工作人员，更多的工作人员时间，更多的设备，专门的护理单位，甚至避免入院， 肥胖的人目前还不知道哪种适应战略在国家卫生机构中占主导地位，哪种适应战略 战略与改善健康和安全相关，或者哪些适应战略与 不良安全事件增加。由于这些安全性问题和缺乏基于证据的适应性 战略建议，迫切需要对适应进行大规模评估， 国家卫生机构用来维持肥胖居民健康和安全的策略，并将这些方法与 其他关键设施特征和个体结果。我们提出以下目标，以提高安全性， 肥胖的居民。在目标1中，我们将优先考虑并确定安全性问题的普遍性 以及通过对护理服务的结构化研究观察为肥胖居民提供的适应性， 对利益相关者的半结构化访谈，以及对国家卫生机构的大规模调查。在目标2中，我们将检查 不同类型的适应策略与居民不良安全性事件组合之间的关系 结局，包括压疮、伤口感染、尿路感染、福尔斯和再次入院， 使用国家NH评估数据。在目标3中，我们将为决策者开发和验证一个工具包， 护理人员，以促进最有效的适应战略在国家卫生机构的实施。这项工作将提供 定性和定量的循证研究，并开发循证工具，以帮助实施 改善数十万脆弱的NH肥胖居民的安全和护理。

PROJECT ABSTRACT In the research proposed here, we will evaluate the strategies nursing homes (NHs) use to prevent adverse safety events affecting residents with obesity and develop an evidence-based toolkit to help NHs adapt to the increasing care challenges for residents with obesity. Thirty percent of the 1.4 million NH residents in the U.S. are obese, and every day, resident obesity makes it more difficult to provide safe, high-quality nursing and custodial care in the more than 15,000 NHs in the U.S. Obese residents require much more nursing and custodial assistance with daily activities such as mobility, toileting, and skin assessments. NH residents with obesity are at high risk for adverse safety events such as preventable pressure ulcers, infections, falls, and hospital readmissions. To cope with these challenges, NHs may adapt to the needs of obese residents and prevent adverse safety events through organizational adaptation strategies that utilize some combination of more staff members, more staff time, more equipment, specialized nursing units, or even avoiding admission of obese individuals. It is not known which adaptation strategies predominate across NHs, which adaptation strategies are associated with improved health and safety, or which adaptation strategies are associated with increased adverse safety events. Due to these safety concerns and the lack of evidence-based adaptation strategy recommendations, there is a critical need to perform a large-scale evaluation of the adaptation strategies NHs use to maintain the health and safety of obese residents and associate these methods with other key facility characteristics and individual outcomes. We propose the following aims to improve safety for residents with obesity in NHs. In Aim 1, we will prioritize and determine the prevalence of the safety concerns and available adaptations for residents with obesity through structured research observations of care delivery, semi-structured interviews of stakeholders, and a large national survey of NHs. In Aim 2, we will examine the relationship between different types of adaptation strategies and a resident adverse safety events composite outcome, including pressure ulcers, wound infections, urinary tract infections, falls, and hospital readmissions, using national NH assessment data. In Aim 3, we will develop and validate a toolkit for decision makers and caretakers to facilitate implementation of the most effective adaptation strategies in NHs. This work will provide qualitative and quantitative evidence-based research and develop evidence-based tools to help implement improved safety and care of hundreds of thousands of vulnerable NH residents with obesity.