Disparities in Incontinence and Perineal Skin Damage in Nursing Home Elders

疗养院老年人失禁和会阴皮肤损伤的差异

• 批准号: 8488484
• 负责人: DONNA Z BLISS
• 金额: $ 39.27万
• 依托单位: UNIVERSITY OF MINNESOTA
• 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 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8488484
• 关键词: Accounting; Address; Admission activity; Age; Area; Attention; Behavior; Benchmarking; Caring; Censuses; Certification; Characteristics; Clinical; Communities; Complex; Consensus; Data; Data Set; Databases; Decubitus ulcer; Dermatitis; Development; Diabetes Mellitus; Disadvantaged; Discipline of Nursing; Discrimination; Early identification; Economics; Effectiveness; Elderly; Environment; Epidemiologic Studies; Epidemiology; Ethics; Ethnic Origin; Ethnic group; Evaluation; Extravasation; Fecal Incontinence; Feces; Financial cost; Future; Genetic; Goals; Health; Health Services Accessibility; Healthcare; Hispanics; Home Nursing Care; Incidence; Incontinence; Individual; Intervention; Investigation; Knowledge; Link; Measurement; Measures; Medicare/Medicaid; Minority; Minority Groups; Modeling; Monitor; Nature; Neighborhoods; Nursing Homes; Nursing Staff; Obesity; Outcome; Pain; Personal Satisfaction; Pharmaceutical Preparations; Play; Policies; Population; Prevalence; Prevention; Quality of Care; Quality of life; Race; Recommendation; Recording of previous events; Records; Relative (related person); Reporting; Research; Research Priority; Resolution; Risk; Role; Sampling; Science; Septicemia; Skin; Social Justice; Societies; Socioeconomic Status; Source; Subgroup; Surveys; Techniques; Thinking; Time; Treatment Cost; United States; United States National Institutes of Health; Urban Hospitals; Urinary Incontinence; Urine; Visit; Weight; base; cost; demographics; design; evidence base; experience; health disparity; improved; innovation; interest; member; nursing home length of stay; prevent; psychologic; psychological distress; racial and ethnic; racial and ethnic disparities; restraint; skin color; social; socioeconomics; symposium; theories; treatment planning; universal prevention; urinary

DESCRIPTION (provided by applicant): This is a study of race, ethnic, and socioeconomic (SES) disparities as they relate to the development and management of incontinence, perineal dermatitis (PD), pressure ulcers (PUs) and associated quality of life in older nursing home (NH) residents. Reports of disparities in incontinence and perineal skin damage and their management are a serious ethical and clinical concern warranting further investigation. Incontinence, PUs and PD are long-standing, widespread, and costly problems to which race, ethnic and SES disparities may contribute significantly. Annual treatment costs are in the billions of dollars, and each condition is significantly associated with psychological distress, physical discomfort, and lower quality of life. Complications of PUs can be fatal. Reducing health disparities offers a profound opportunity for improving the health of disadvantaged minority populations. Because health outcomes of NH residents and disparities in those outcomes are influenced by multiple factors at the individual, group NH, and community levels before and during a NH stay, investigation to detangle their contributions requires a multi-level approach. Previous studies have focused primarily on individual level resident characteristics or controlled for only a few NH factors; none has used a multi-level, multi-factoral approach. Because of our datasets, we are uniquely able to simultaneously measure factors at the individual, NH, and community levels that are associated with disparities in the development, prevention, and management of fecal and/or urinary incontinence, PD, PUs, and associated quality of life. We will analyze three large population datasets: Minimum Data Set (MDS) records and practitioner orders for all residents of a large, for-profit NH chain, the Online Survey, Certification and Reporting (OSCAR) files, and the US Census tract data. In addition, we will compare disparities in these health conditions and management plans in residents of the proprietary set of NHs with those in a set of national for-profit and non-profit NHs using a fourth database of MDS records (without practitioner orders) and OSCAR, and Census data in a multi-level sensitivity analysis. In so doing, we will provide context to our findings and strengthen our ability to make more informed recommendations. Our study will provide the best evidence to date about which of the many possible modifiable factors associated with disparities in these outcomes should be targeted for intervention and ascertain the level of their contribution. Therefore, our findings are critical before interventions aimed at reducing disparities in incontinence and perineal skin damage can be undertaken or successful.

描述（由申请人提供）：这是一项关于种族、民族和社会经济 (SES) 差异的研究，因为它们与老年疗养院 (NH) 居民失禁、会阴皮炎 (PD)、压疮 (PU) 的发展和管理以及相关生活质量有关。关于失禁和会阴皮肤损伤及其处理差异的报告是一个严重的伦理和临床问题，值得进一步调查。失禁、PU 和 PD 是长期存在、广泛存在且代价高昂的问题，种族、民族和社会经济地位差异可能会在很大程度上造成这些问题。每年的治疗费用高达数十亿美元，每种病症都与心理困扰、身体不适和生活质量下降显着相关。 PU 的并发症可能是致命的。减少健康差距为改善弱势少数群体的健康提供了巨大的机会。由于 NH 居民的健康结果以及这些结果的差异受到 NH 入住前和期间的个人、团体 NH 和社区层面的多种因素的影响，因此需要采取多层次的方法来调查他们的贡献。以前的研究主要集中在个人层面的居民特征或仅控制少数NH因素；没有一个国家采用多层次、多因素的方法。由于我们的数据集，我们能够同时测量个人、NH 和社区层面的因素，这些因素与大便和/或尿失禁、PD、PU 和相关生活质量的发展、预防和管理差异相关。我们将分析三个大型人口数据集：大型营利性 NH 连锁店所有居民的最小数据集 (MDS) 记录和从业者订单、在线调查、认证和报告 (OSCAR) 文件以及美国人口普查区数据。此外，我们将使用第四个 MDS 记录数据库（无医生订单）和 OSCAR 以及多级敏感性分析中的人口普查数据，比较专有 NH 集合中的居民与一组国家营利性和非营利性 NH 中的居民在这些健康状况和管理计划方面的差异。在此过程中，我们将为我们的发现提供背景信息，并增强我们提出更明智建议的能力。我们的研究将提供迄今为止最好的证据，说明与这些结果差异相关的许多可能可改变因素中的哪些因素应作为干预目标，并确定其贡献水平。因此，在采取或成功采取旨在减少失禁和会阴皮肤损伤差异的干预措施之前，我们的研究结果至关重要。