Cost-Effectiveness of Two Nutrition Interventions in Long-Term Care

描述(申请人提供)：食物和液体摄入不足是疗养院(NH)居民的常见问题，可能导致营养不良、脱水、体重减轻、住院，甚至死亡。对高危NH居民的最常见的营养干预是口服液体营养补充剂，尽管关于补充剂促进NH居民体重增加的有效性的受控证据有限。此外，研究表明，补充剂的提供不符合订单，居民在日常保健实践中几乎没有得到工作人员的帮助来促进消费。其结果是，营养风险高的NH居民接受补充剂订单，每天从补充剂中获得的额外卡路里很少。最近的证据有力地表明，为居民提供各种食物和液体之间的选择，每天多次，再加上帮助，在增加每日卡路里摄入量和促进体重增加方面是有效的。然而，提供餐间选择干预需要的工作人员时间远远多于NH工作人员目前在餐间营养护理方面所花费的时间。一项新的联邦法规允许NHS培训非护理人员提供喂养辅助护理。初步研究表明，受过“喂养助理”培训的非护理人员在用餐时提供的喂养辅助护理可与当地护士助理的同行相媲美或更好。此外，最近的一项示范项目表明，在日常护理实践中，这些工作人员可以有效地增加护士助理人员，提供膳食喂养辅助护理服务。拟议的转化性研究将利用联邦法规培训非护理人员提供餐间营养护理。具体地说，拟议的研究将使用受控干预设计，以确定餐间选择干预相对于常规护理对照组的成本效益，该小组由4个保健地点的200名居民组成。接受热量补充的居民将包括在这项研究中，并被随机分为常规护理对照组或选择性干预组(每组100名居民)。常规护理控制组将继续接受标准的NH护理，以补充或在两餐之间递送零食，由土著护士助理人员提供。接受过“喂养助理”培训的非护理人员将为干预组的居民提供补充剂和其他零食和液体之间的选择，每周五天，每天两次，为期24周，同时还提供标准化的提示方案，以增加摄入量和饮食独立性。研究人员将独立记录实施干预的成本，并将这些成本与有效性措施进行比较，其中包括改善卡路里摄入量、体重和生活质量。这些结果将由训练有素的研究人员使用标准化的、经过验证的方案在24周内对两组患者进行独立监测。这项转化研究工作将提供关键信息，以改善疗养院对营养风险居民的护理实践。 公共卫生相关性：拟议的翻译研究的目的是评估餐间选择营养干预改善长期疗养院(NH)居民每日卡路里摄入量和体重状况的比较成本效益。将使用受控干预设计，研究人员将在4个NH地点的250名居民中培训疗养院工作人员在两餐之间进行干预交付。居民结果将由研究人员独立监测，包括卡路里摄入量、体重和生活质量指标的变化。

DESCRIPTION (provided by applicant): Inadequate food and fluid intake is a common problem among nursing home (NH) residents and one that can lead to under-nutrition, dehydration, weight loss, hospitalization, and even death. The most common nutrition intervention for at-risk NH residents is oral liquid nutrition supplementation, although, there is limited controlled evidence of the efficacy of supplements in promoting weight gain in NH residents. Moreover, studies show that supplements are not provided consistent with orders and residents receive little to no staff assistance to promote consumption in daily NH care practice. The result is that nutritionally at-risk NH residents with supplement orders receive few additional daily calories from supplements. Recent evidence strongly suggests that offering residents a choice among a variety of foods and fluids multiple times per day between meals coupled with assistance is effective in increasing daily caloric intake and promoting weight gain. However, the provision of the between-meal choice intervention requires significantly more staff time relative to the amount of time NH staff currently spend on between-meal nutritional care provision. A new federal regulation allows NHs to train non-nursing staff to provide feeding assistance care. Preliminary research has demonstrated that non-nursing staff trained as "feeding assistants" provide mealtime feeding assistance care that is comparable to or better than their indigenous nurse aide counterparts. Moreover, a recent demonstration project showed that these staff can be used to effectively augment nurse aide staff for mealtime feeding assistance care provision in daily care practice. The proposed translational study will utilize the federal regulation to train non-nursing staff for between-meal nutritional care delivery. Specifically, the proposed study will use a controlled, intervention design to determine the cost-effectiveness of the between-meal choice intervention relative to a usual care control group in a group of 200 residents across 4 NH sites. Residents with an order for caloric supplementation will be included in this study and randomized into either a usual care control group or a choice intervention group (100 residents per group). The usual care control group will continue to receive standard NH care for supplement or snack delivery between meals, as provided by indigenous nurse aide staff. Non-nursing staff trained as "feeding assistants" will offer residents in the intervention group a choice between supplements and other snack foods and fluids twice daily, five days per week, for 24 weeks while also providing a standardized prompting protocol to enhance intake and independence in eating. Research staff will independently document the costs of intervention implementation and compare these costs to effectiveness measures which include improvements in caloric intake, weight and quality of life. These outcomes will be independently monitored for both groups across 24 study weeks by trained research staff using standardized, validated protocols. This translational research effort will provide critical information to improve care practices in nursing homes for nutritionally at risk residents. PUBLIC HEALTH RELEVANCE: The purpose of the proposed translational research study is to evaluate the comparative cost-effectiveness of a between-meal choice nutrition intervention for improving daily caloric intake and weight status in long-stay nursing home (NH) residents. A controlled intervention design will be used wherein research staff will train nursing home staff in intervention delivery between meals in a group of 250 residents across 4 NH sites. Resident outcomes, which will be independently monitored by research staff, include changes in caloric intake, body weight and quality of life measures.