TAMI: Technology Assisted Management of Incontinence

描述（由申请人提供）：体弱多病、老龄化人口与为老年人提供护理的护理人员之间的差距正在扩大，并将继续以惊人的速度扩大。虽然政府和公众可能会要求养老院为老年居民提供高质量的护理，但目前的预期支付制度并没有足够的补偿设施，以雇用和保留适当的人员水平。居民的生活质量与护理人员直接护理时间之间的相关性是有充分记录的；然而，如果不对报销制度进行重大改革，居民将来用于直接护理的时间应该会更少。失禁是许多老年人住院治疗的一种情况。提供失禁护理所需的工作人员时间是大量的。拟议的研究将调查技术辅助失禁管理（TAMI）系统的功效，该系统解决了用于衡量所有养老院提供的护理质量的三个关键质量指标。研究人员假设使用TAMI系统将减少提供失禁护理所需的总时间，同时改善个体化护理。对养老院的居民、工作人员和管理人员的总体潜在好处包括改善居民的生活质量，提高工作人员的生产力，减少因在潮湿环境中度过的时间而导致的成本和皮肤损伤所造成的痛苦。最终，预计养老院可以利用净节省的劳动力，进一步把注意力集中在其他基础和预防性护理过程。拟议的临床研究将在3家养老院进行，采用重复测量设计，以确定使用拟议的技术是否1)在提供失禁护理时节省时间，2)减少换内裤时皮肤湿润，3)减少可漂白红斑的发生率，4)在研究人员不在场时持续有效地使用，5)从设施的角度来看具有成本效益。6)结果是家庭愿意支付的照护得到明显改善。讨论了该过程质量控制系统的商业潜力。以前将类似技术引入养老院的尝试遇到了阻力，主要是由于成本、操作不便和效率低下。此外，这些系统的设计并不是为了满足养老院护理过程中最关键的要素：护士助理的需求。失禁是许多老年人住院治疗的一种疾病，需要大量的劳动来预防和治疗。我们假设使用技术辅助失禁管理：TAMi将通过有针对性的干预减少提供失禁护理所需的总时间，并且养老院可以利用净节省的劳动力来参加其他基本和预防性护理过程。这种节省时间的总体潜在好处包括改善生活质量、提高员工生产力，以及避免不良结果所带来的潜在成本节约。

DESCRIPTION (provided by applicant): The disparity between the size of the frail, aging population and the nursing workforce that provides care for the elderly is growing, and will continue to expand at an alarming rate. Though the government and the public may demand that nursing homes provide high quality of care to elder residents, the current prospective payment system does not sufficiently reimburse facilities to hire and retain appropriate staffing levels. The correlation between a resident's quality of life and the amount of direct care time spent with nursing staff is well documented; however, without significant changes to the reimbursement system, residents should expect even less time devoted to direct care in the future. Incontinence is a condition for which many older adults are institutionalized. Staff time required to provide incontinence care is substantial. The proposed study will investigate the efficacy of a technology-assisted management of incontinence (TAMI) system that addresses three of the key quality indicators used to measure the quality of care provided by all nursing homes. Investigators hypothesize that use of the TAMI system will reduce the total time required to deliver incontinence care, while simultaneously improving individualized care. The overall potential benefits for residents, staff and management of nursing homes include improved quality of life for residents, higher staff productivity, and reduction in cost and suffering caused by skin breakdown related to time spent in wet conditions. Ultimately it is expected that nursing homes can utilize net savings in labor to further focus attention on other basic and preventive care processes. The proposed clinical study will be conducted in 3 nursing home facilities using a repeated measures design to determine if use of the proposed technology 1) incurs time savings in the provision of incontinence care, 2) reduces skin wetness upon change of briefs, 3) reduces incidence of blanchable erythema, 4) is consistently and effectively utilized when research staff are not present, 5) is cost effective from the perspective of facilities, and 6) results in perceived improvements in care for which families are willing to pay. The commercial potential for this process quality control system is discussed. Previous attempts to introduce similar technology into the nursing home facility have met resistance primarily due to the cost, unwieldy operation, and ineffectiveness. Moreover, the systems were not designed to meet the needs of the most critical element within the nursing home care process: the nurse aide. Incontinence is a condition for which many older adults are institutionalized and are labor intensive to prevent and to treat. We hypothesize that use of Technology Assisted Management of Incontinence: TAMi will reduce the total time required to deliver incontinence care through targeted intervention and that nursing homes can utilize the net savings in labor to attend to other basic and preventive care processes. The overall potential benefits of this time savings include improved quality of life, higher staff productivity, and potential cost savings resulting from avoidance of adverse outcomes.