Infection Prevention in Home Health Care (InHOME)

家庭保健中的感染预防 (InHOME)

• 批准号: 10610965
• 负责人: Jingjing Shang
• 金额: $ 84.96万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-21 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10610965
• 关键词: Adult; Advocate; Affect; American; COVID-19; COVID-19 disparity; COVID-19 mortality; COVID-19 pandemic; COVID-19 risk; Caregivers; Caring; Certification; Cessation of life; Clinical; Collaborations; Communicable Diseases; Communities; Complex; Consensus; Country; Data; Disadvantaged; Disparity; Economically Deprived Population; Elderly; Emergency Situation; Employee; Environment; Evolution; Female; Future; Guidelines; Health Care Sector; Health Care Surveys; Health Personnel; Home; Home Care Services; Home Health Care Agencies; Hospitalization; Hospitals; Individual; Infection; Infection Control; Infection prevention; Interview; Knowledge; Link; Literature; Measures; Medicare; Medicare claim; Methods; Modeling; National Institute on Minority Health and Health Disparities; Outcome; Participant; Patient Care; Patient-Focused Outcomes; Patients; Persons; Policies; Population; Procedures; Process; Public Health; Qualifying; Readiness; Recommendation; Reduce health disparities; Reporting; Research Personnel; Review Literature; Risk; Rural Community; Source; Surveys; Time; Training; Vulnerable Populations; Work; beneficiary; coronavirus disease; design; dissemination strategy; ethnic minority; evidence base; evidence based guidelines; experience; health care service; health care settings; health disparity; high risk; improved; infection risk; insight; member; minority health; minority health disparity; mortality; multidisciplinary; multiple chronic conditions; pandemic disease; parent grant; patient population; personal protective equipment; policy recommendation; pre-pandemic; racial minority; rural underserved; social health determinants; socioeconomic disadvantage

Home healthcare (HHC) is the fastest growing healthcare sector and an important source of care for older Americans, including populations that historically have been vulnerable to health disparities. HHC patients are at high risk for infections. The COVID-19 pandemic has put a spotlight on infection prevention and control (IPC). However, our prior work indicates that HHC IPC capacity (i.e., IPC staffing, general IPC procedures, infection specific policies and employee IPC training policies) was sub-optimal and IPC preparedness (i.e., planning for and responding to an infectious disease crisis) was insufficient before the pandemic. Informed by our work in the parent grant “Infection Prevention in Home Health Care (InHOME, R01 NR016865)” and guided by Donabedian’s Quality Model and the Minority Health and Health Disparities Framework, in this competitive renewal we propose a 5-year, mixed methods study with 4 aims: 1) To describe changes in HHC IPC capacity and preparedness over time and its association with vulnerable populations; 2) To examine associations between HHC IPC capacity and HHC patient outcomes, overall and in vulnerable populations; 3) To examine the feasibility and potential barriers to implementing best practices in IPC capacity and preparedness through qualitative interviews with HHC personnel; and, 4) To develop evidence-based recommendations for improving HHC IPC capacity and preparedness to reduce the burden of COVID-19 and non-COVID-19 infections in HHC. In Aim 1, we will conduct two national surveys of HHC agencies (n = 600 per survey) in 2022 and 2024 and link them with our 2019 survey. We will assess the evolution of HHC IPC capacity and preparedness across the nation. In Aim 2, we will estimate the associations between HHC IPC capacity and HHC patient outcomes (infections, mortality) by linking our surveys with longitudinal HHC assessments (i.e., the Outcome and Assessment Information Set), Medicare claims and encounters data, and COVID-19 environment data. In Aim 3, we will conduct qualitative interviews with 60 purposively selected HHC personnel (i.e., 20 HHC agencies, 3 participants per agency) to discuss our findings, gather insights, and gain perspectives from those with firsthand experience implementing IPC policies and caring for patients. In Aim 4, we will conduct systematic literature review and synthesize our findings to inform a Delphi panel made up of key stakeholders (i.e., experts, leaders, advocates, patients and caregivers). We will develop clinical and policy recommendations refined and endorsed by our Delphi panel. This will result in data-driven, evidence-based recommendations that we will widely disseminate. Our multidisciplinary team is uniquely qualified to conduct this study. Leveraging our unique baseline data, our study will be the first comprehensive examination of IPC changes in HHC through the pandemic and its impact on patient outcomes. The results will provide recommendations to strengthen HHC agencies’ IPC capacity and preparedness to more effectively respond to the current and future infectious disease crises, protect the millions of Americans using HHC services every year, and reduce health disparities.

家庭医疗保健(HHC)是增长最快的医疗保健部门，也是老年人护理的重要来源 美国人，包括历史上易受健康差距影响的人群。HHC患者是 感染的风险很高。新冠肺炎疫情使预防和控制感染成为人们关注的焦点 (IPC)。然而，我们先前的工作表明，HHC IPC能力(即IPC人员配置、一般IPC程序、 感染特定策略和员工IPC培训策略)不是最优的，并且IPC准备(即， (规划和应对传染病危机)在大流行之前是不够的。通知人 我们在家长资助和指导下的工作《家庭保健中的感染预防(在家中，R01 NR016865)》 根据多纳贝迪安的质量模型和少数群体健康和健康差距框架，在这场竞争中 我们提出了一项为期5年的混合方法研究，目的有4个：1)描述HHC IPC能力的变化 以及随时间变化的准备情况及其与弱势群体的关联；2)审查关联 HHC IPC能力和HHC患者结果之间的关系，总体上和在脆弱人群中；3)检查 通过以下途径实施综合方案能力和备灾工作最佳做法的可行性和潜在障碍 与HHC人员进行定性访谈；以及，4)制定以证据为基础的改进建议 HHC IPC能力和准备，以减少HHC中新冠肺炎和非新冠肺炎感染的负担。 在目标1中，我们将在2022年和2024年对HHC机构进行两次全国调查(每次调查600人)，并将 他们与我们2019年的调查。我们将评估HHC IPC能力的演变和整个 国家。在目标2中，我们将评估HHC IPC能力和HHC患者预后之间的关系 (感染、死亡率)，通过将我们的调查与HHC纵向评估(即结果和 评估信息集)、联邦医疗保险索赔和遭遇数据以及新冠肺炎环境数据。在AIM 我们将对60名故意挑选的HHC人员进行定性访谈(即20个HHC机构，3 每个机构的参与者)讨论我们的调查结果，收集见解，并从具有 有实施IPC政策和照顾病人的第一手经验。在目标4中，我们将进行系统的 文献回顾和综合我们的发现，以向由关键利益相关者(即， 专家、领导、倡导者、患者和照顾者)。我们将制定临床和政策建议 我们的德尔福小组对其进行了改进和认可。这将产生数据驱动的、基于证据的建议 我们将广泛传播。我们的多学科团队是唯一有资格进行这项研究的人。利用 我们独特的基线数据，我们的研究将是第一次全面检查HHC中IPC的变化 大流行及其对患者预后的影响。研究结果将为加强HHC提供建议 各机构的IPC能力和准备，以更有效地应对当前和未来的传染病 疾病危机，保护每年使用HHC服务的数百万美国人，并减少健康差距。