Pressure ulcer prevention and treatment media

描述(由申请人提供)：压疮是长期保健中的一个重大问题。长期和长期护理环境中的流行率估计在8%左右，在过去十年中似乎稳定。据估计，新加入居家护理的人中有30%面临患压疮的风险。然而，有强有力的论点认为，只要遵循适当的预防标准，压疮在很大程度上是可以预防的，无论患者的Braden风险状况如何。虽然减少到零可能是不现实的，特别是在短期内，由于美国医疗保健系统普遍存在的制度性、系统性和个体性因素，但从目前的长期和居家护理的发病率降低是可行的，并将通过减少患者后遗症和共同发病率来节省人力和财力。改进对标准预防、治疗和管理做法的遵守是一个合理和有价值的目标。学术边缘公司(AEI)正在开发一套教育材料和支持资源，以解决压疮的预防和治疗问题。这些将通过网络和其他媒体提供。这些材料将是互动性的、准确的、有效的和可扩展的。媒体和网站将从预防和治疗两个方面解决压疮问题，并将针对家庭卫生助理(HHA)、护士和其他监督人员，以及在较小但同样重要的程度上，针对患者及其家人。在第一阶段，AEI通过确定突出的HHA信念、生成核心内容和设计文件、通过最终用户焦点小组和主题专家(SME)审查对这些文件进行评估、制作涵盖部分内容的视频并对该视频进行现场试验，展示了这项工作的可行性。第二阶段将开发两个互动课程，一个压疮信息门户网站，以及工作辅助和其他绩效支持工具，以提高四个关键目标的绩效：(1)监测压疮迹象，(2)采取积极措施识别、监测和减轻风险因素，(3)使用当前标准做法管理压疮，以及(4)监督与压疮形成风险人群互动的其他人。将使用以理论为基础的设计和开发模式来制定这些方案，并将利用重点小组和咨询小组审查对其进行持续评估。核心内容和课程还将在两组实地试验中进行评估：每门课程的初步小规模形成性验证试验(n=20)，以确保每门课程中的一切正常运行；以及一组更大的终结性试验(n=440名家庭保健人员；n=120名护理学生)，以评估工作的有效性。压疮是长期护理中的一个重要问题。在过去十年中，接受长期居家护理的个人数量迅速增加。家庭保健员是美国增长最快的职业，2004年至2014年期间的增长率预计为56%，同期增加了约35万个工作岗位。尽管大多数家庭保健助理似乎愿意采取措施减少压疮的发生率，但目前还没有针对HHA领域的压疮及其预防的标准化、友好和有效的培训。现有的少量培训通常针对更高级的从业者，并通过书籍和其他纸质媒体做到这一点。一套现成的、循证的和理论驱动的互动课程、工具和资源，用于个人和小组培训，在多种媒体中开发，应该受到家庭卫生组织的极好欢迎，可以被应用于更广泛的应用，如专业前护理培训，并将对这一重要的、基本上可以预防的公共卫生问题产生积极影响。

DESCRIPTION (provided by applicant): Pressure ulcers are a significant problem in long-term health care. Estimates of prevalence in the long-term and extended care environments cluster around 8% and appear stable over the past decade. An estimated 30% of new entrants to homebound care are at risk for developing pressure ulcers. Yet it has been forcefully argued that pressure ulcers are largely preventable regardless of a patient's Braden Risk profile when proper precautionary standards of practice are followed. While reduction to zero may be unrealistic, especially in the near-term as a result of institutional, systemic, and individual factors endemic to the U.S. health care system, nonetheless a reduction from the present rates of incidence in long-term and homebound care is feasible and would yield human and financial savings through diminution of patient sequelae and co-morbidity. Improvement in adherence to standard prevention, treatment, and management practices is a reasonable and worthwhile objective. The Academic Edge, Inc. (AEI) is developing a suite of educational materials and support resources to address prevention and treatment of pressure ulcers. These are to be delivered via web as well as other media. The materials will be interactive, accurate, effective, and extensible. The media and site will address pressure ulcers in terms of both prevention and treatment and will target home health aides (HHA), nurses and other supervisory personnel, and, to a lesser, but no less important extent, patients and their families. In Phase 1, AEI demonstrated the feasibility of the effort by identifying salient HHA beliefs, generating core content and design documents, evaluating those documents through end-user focus groups and subject-matter-expert (SME) reviews, and by producing a video covering a portion of the content and conducting a field trial of that video. Phase 2 will develop two interactive courses, a web portal of pressure ulcer information, and job aids and other performance support tools to increase performance of four key objectives: (1) monitoring for signs of pressure ulcers, (2) taking active steps to identify, monitor, and mitigate risk factors, (3) managing pressure ulcers using current standard practices, and (4) supervising others who interact with those at risk for pressure ulcer formation. These will be developed using a theory-based design and development model and will be evaluated continuously using focus groups and advisory panel reviews. The core content and courses will also be evaluated in two sets of field trials: an initial small scale formative (n=20) validation trial for each course that ensures everything is working correctly in each course and a set of larger summative trials (n=440, home health care personnel; n=120 nursing students) that evaluate the effectiveness of the effort. Pressure ulcers are a significant problem in long-term care. The number of individuals receiving long- term homebound care has increased rapidly in the last decade. Home health aides represent the fastest growing occupation in the U.S., with a projected growth rate of 56% over the 2004-2014 period, adding some 350,000 jobs in that same period. Although most home health aides appear to be willing to take steps to reduce the incidence of pressure ulcers, there presently exists no standardized, friendly, and effective training on pressure ulcers and their prevention for the HHA field. What little training does exist generally targets more advanced practitioners and does so through books and other paper-based media. A readily available, evidence-based, and theory driven set of interactive courses, tools, and resources for individual and small group training, developed in multiple media, should be extremely well-received by home health organizations, can be adapted to be used in broader applications, such as pre-professional nursing training, and will positively affect this important, and mostly preventable, public health concern.