Disparities in Infection in Home Health and Patients/Caregivers' Perceptions (Dis-Infection in HHC)

家庭医疗保健（HHC）是美国最大和增长最快的医疗保健部门之一。HHC 患者存在医疗保健相关感染（HAI）风险;社会经济弱势HHC患者 由于获得医疗资源的机会有限和环境污染的存在， 增加感染风险的危害。只有两项研究调查了HHC患者的社会经济地位 (SES)和感染风险，它们受到数据年龄，当地调查范围和未能衡量的限制 HHC患者居住社区的复杂社会经济组成。感染预防和 在COVID-19大流行期间，HHC的IPC控制（IPC）非常突出，因为HHC服务于弱势人群。 然而，我们发现IPC在HHC中是次优的，HHC临床医生报告说，住房条件差， 患者/非正式护理人员难以遵守建议的做法， IPC在HHC中。在此基础上，以社会生态模型为指导，提出了一个5- 一年，多地点，混合方法的研究，以解决以下目标：1）审查社会经济 HHC患者在COVID-19之前和期间感染事件（包括COVID-19）的差异 大流行; 2）描述HHC患者（或非正式）中的IPC相关知识，态度和实践 护理人员）并检查相关因素; 3）从HHC患者的角度探索IPC实践 (or非正式护理人员）和HHC提供者;以及4）开发和试点测试多模式干预措施，以改善 HHC患者（或非正式护理人员）的IPC知识和实践。我们将合并多个国家 2019-2020年的数据集，包括最新的地区可持续发展指数（ADI）文件，这是一个多维的SES指标， 社区，以研究COVID-19大流行之前和期间与感染相关的健康差异。我们将 由于HHC中四种常见的HAI（呼吸道， 尿路、伤口和静脉导管相关），以及 COVID-19感染感染风险高和极高的患者和/或其非正式护理人员（n = 250)来自两个HHC机构，为大地理区域不同社会经济背景的患者提供服务 将对这些地区进行调查，以了解他们与IPC相关的知识、态度、做法和环境风险 因素使用创新的患者（或非正式护理人员）和HHC提供者的二元访谈分析 访谈（40对），我们将更好地了解患者/护理人员对IPC的障碍，并探索如何最好地 加强患者（或非正式护理人员）与HHC提供者的互动，并改善家中的IPC实践。最后， 我们将对目标1-3的结果进行三角分析，以开发多模式干预，提高IPC知识 在HHC患者和非正式护理人员中进行了实践，并在30名患者中进行了初步测试 种族/民族和SES背景。由一个多学科小组进行，该项目的结果将被用于 以指导HHC环境中未来的临床IPC实践。

Home health care (HHC) is one of the largest and most rapidly growing health care sectors in the nation. HHC patients are at risk for healthcare associated infections (HAIs); socioeconomically disadvantaged HHC patients may be more prone to infections due to limited access to healthcare resources and presence of environmental hazards that increase infection risk. Only two studies have examined HHC patients' socioeconomic status (SES) and infection risk, and they are limited by the age of data, local scope of inquiry, and failure to measure the complex socio-economic composition of communities where HHC patients reside. Infection prevention and control (IPC) in HHC is prominent during the COVID-19 pandemic as HHC serves a vulnerable population. However, we found IPC is suboptimal in HHC and HHC clinicians reported that poor housing conditions and difficulties with patient/informal caregiver compliance with recommended practices pose specific challenges to IPC in HHC. Building upon our previous studies and guided by the Social-Ecological Model, we propose a 5- year, multi-site, mixed methods research study to address following aims: 1) examine socio-economic disparities in infection events, including COVID-19, among HHC patients before and during the COVID-19 pandemic; 2) describe IPC-related knowledge, attitudes, and practices among HHC patients (or informal caregivers) and examine associated factors; 3) explore IPC practices from the perspectives of HHC patients (or informal caregivers) and HHC provider; and 4) develop and pilot test a multi-modal intervention to improve knowledge and practice of IPC in HHC patients (or informal caregivers). We will merge multiple national datasets from 2019-2020 with the latest Area Deprivation Index (ADI) file, a multidimensional SES measure of neighborhoods, to study infection-related health disparities before and during the COVID-19 pandemic. We will study hospital transfers or emergency care visits due to four commonly reported HAIs in HHC (respiratory, urinary tract, wound and intravenous catheter-related) that occur 2 days after HHC admission as well as COVID-19 infections. Patients with high and very high risk of infection and/or their informal caregivers (n = 250) from two HHC agencies serving patients with diverse socioeconomic backgrounds in large geographic areas will be surveyed to understand their IPC-related knowledge, attitudes, practices and environmental risk factors. Using innovative dyadic interview analysis of both patient (or informal caregiver) and HHC provider interviews (40 pairs), we will better understand patient/caregivers’ barriers to IPC and explore how best to enhance patient (or informal caregiver)-HHC provider interactions and improve IPC practices at home. Finally, we will triangulate the results from Aims 1-3 to develop a multimodal intervention to improve IPC knowledge and practices among HHC patients and informal caregivers, and pilot test it among 30 patients across all racial/ethnic and SES backgrounds. Conducted by a multi-disciplinary team, findings of this project will be used to guide future clinical IPC practices in HHC settings.