TAMI: Technology Assisted Management of Incontinence

描述(申请人提供)：虚弱、老龄化的人口规模与为老年人提供护理服务的护理劳动力之间的差距正在扩大，并将继续以惊人的速度扩大。尽管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不足以偿还设施，以雇用和保留适当的人员配备水平。居民的生活质量与与护理人员共处的直接护理时间之间的相关性得到了很好的证明；然而，在补偿制度没有重大变化的情况下，居民未来用于直接护理的时间应该会更少。大小便失禁是许多老年人被收容的一种情况。提供大小便失禁护理所需的工作人员时间很长。这项拟议的研究将调查技术辅助的大小便失禁管理(TAMI)系统的有效性，该系统涉及用于衡量所有疗养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系统将减少提供大小便失禁护理所需的总时间，同时改善个性化护理。疗养院对居民、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，以及减少因在潮湿条件下度过的时间而导致的皮肤破裂所造成的成本和痛苦。最终，预计养老院可以利用净节省的劳动力来进一步关注其他基本和预防性护理过程。拟议的临床研究将在3家疗养院设施中进行，采用重复措施设计，以确定使用拟议技术是否1)节省提供大小便失禁护理的时间，2)减少更换内裤时的皮肤湿润，3)减少可褪色红斑的发生率，4)在研究人员不在场的情况下持续有效地利用，5)从设施的角度来看是具有成本效益的，以及6)导致家庭愿意支付的护理质量的改善。讨论了该工艺质量控制系统的商业潜力。以前将类似技术引入疗养院设施的尝试都遇到了阻力，主要是因为成本、操作笨拙和效率低下。此外，这些系统的设计没有满足疗养院护理流程中最关键的因素：护士助理的需求。大小便失禁是许多老年人被收容的一种情况，预防和治疗是劳动密集型的。我们假设，使用技术辅助的失禁管理：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，疗养院可以利用节省的净劳动力来从事其他基本和预防性护理过程。这一节省时间的总体潜在好处包括改善生活质量、提高工作人员生产率，以及因避免不利后果而潜在的成本节约。

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.