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，我们将评估疗养院(NHS)使用的预防不良反应的策略 影响肥胖居民的安全事件并开发基于证据的工具包，以帮助NHS适应 肥胖居民面临越来越多的护理挑战。在美国140万NH居民中，有30% 肥胖，居民肥胖每天都使提供安全、高质量的护理和护理变得更加困难 美国超过15,000名NHS的看护服务。肥胖居民需要更多的护理和 为日常活动提供看管帮助，如行动能力、如厕和皮肤评估。全日制居民 肥胖是不良安全事件的高风险，如可预防的压疮、感染、跌倒和 再次入院治疗。为了应对这些挑战，NHS可能会适应肥胖居民的需求，并 通过组织适应战略预防不良安全事件，这些战略利用以下几个方面的组合 更多的工作人员，更多的工作时间，更多的设备，专门的护理单元，甚至避免入院 肥胖的人。目前尚不清楚哪些适应策略在整个NHS中占主导地位，哪些适应 策略与改善健康和安全相关，或者与哪些适应策略相关 不良安全事件增多。由于这些安全问题和缺乏循证适应 战略建议，迫切需要对适应工作进行大规模评估 NHS用来维护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人成果。我们建议以下目标来提高安全 英国国民健康保险制度中肥胖的居民。在目标1中，我们将对安全问题的普遍性进行优先排序和确定 以及通过对护理提供的结构化研究观察，为肥胖居民提供可用的适应， 对利益相关者的半结构化采访，以及对NHS的大型全国调查。在目标2中，我们将研究 不同类型适应策略与居民不良安全事件复合体的关系 结果，包括压疮、伤口感染、尿路感染、跌倒和重新入院， 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工具包 促进国民保健制度中最有效的适应战略的实施。这项工作将提供 基于证据的定性和定量研究，并开发基于证据的工具以帮助实施 改善了数十万患有肥胖症的NH脆弱居民的安全和护理。

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.