Disparities in Incontinence and Perineal Skin Damage in Nursing Home Elders

描述（由申请人提供）：这是一项研究种族、民族和社会经济（SES）差异，因为它们与老年疗养院（NH）居民尿失禁、会阴皮炎（PD）、压疮（PU）和相关生活质量的发展和管理有关。关于尿失禁和会阴皮肤损伤及其处理的差异的报告是一个严重的伦理和临床问题，需要进一步研究。不稳定，PU和PD是长期存在的，广泛的，昂贵的问题，种族，民族和社会经济地位的差异可能会显着贡献。每年的治疗费用高达数十亿美元，每种疾病都与心理困扰、身体不适和生活质量下降密切相关。PU的并发症可能是致命的。减少健康差距为改善弱势少数群体的健康状况提供了一个重要的机会。由于NH居民的健康结果和这些结果的差异受到个人，团体NH和社区层面的多种因素的影响，在NH停留之前和期间，调查，以理清他们的贡献需要一个多层次的方法。以前的研究主要集中在个人层面的居民特征或控制只有少数NH因素，没有使用多层次，多因素的方法。由于我们的数据集，我们独特地能够同时测量个人，NH和社区水平的因素，这些因素与大便和/或尿失禁，PD，PU和相关生活质量的发展，预防和管理的差异有关。我们将分析三个大型人口数据集：最小数据集（MDS）记录和从业者订单的所有居民的大型，营利性NH链，在线调查，认证和报告（OSCAR）文件，以及美国人口普查区数据。此外，我们将比较这些健康状况和管理计划的差异，在一组国家营利性和非营利性的NHS使用MDS记录（没有医生的订单）和OSCAR的第四个数据库，在多层次的敏感性分析人口普查数据的专有设置的NHS的居民。在这样做时，我们将为我们的调查结果提供背景，并加强我们提出更明智建议的能力。我们的研究将提供迄今为止最好的证据，说明与这些结果差异相关的许多可能的可改变因素中，哪些应作为干预的目标，并确定其贡献水平。因此，我们的研究结果是至关重要的干预措施，旨在减少失禁和会阴皮肤损伤的差异可以进行或成功。公共卫生相关性：这是一项研究的差异，在非自愿泄漏的尿液和粪便，相关的皮肤损伤，以及生活质量的存在，因为种族，民族背景，社会和经济地位的老年疗养院居民。本研究还将研究养老院和社区因素，这些因素可能在这些健康问题的发生，预防和管理中发挥作用，这些健康问题大大降低了身心健康。

DESCRIPTION (provided by applicant): This is a study of race, ethnic, and socioeconomic (SES) disparities as they relate to the development and management of incontinence, perineal dermatitis (PD), pressure ulcers (PUs) and associated quality of life in older nursing home (NH) residents. Reports of disparities in incontinence and perineal skin damage and their management are a serious ethical and clinical concern warranting further investigation. Incontinence, PUs and PD are long-standing, widespread, and costly problems to which race, ethnic and SES disparities may contribute significantly. Annual treatment costs are in the billions of dollars, and each condition is significantly associated with psychological distress, physical discomfort, and lower quality of life. Complications of PUs can be fatal. Reducing health disparities offers a profound opportunity for improving the health of disadvantaged minority populations. Because health outcomes of NH residents and disparities in those outcomes are influenced by multiple factors at the individual, group NH, and community levels before and during a NH stay, investigation to detangle their contributions requires a multi-level approach. Previous studies have focused primarily on individual level resident characteristics or controlled for only a few NH factors; none has used a multi-level, multi-factoral approach. Because of our datasets, we are uniquely able to simultaneously measure factors at the individual, NH, and community levels that are associated with disparities in the development, prevention, and management of fecal and/or urinary incontinence, PD, PUs, and associated quality of life. We will analyze three large population datasets: Minimum Data Set (MDS) records and practitioner orders for all residents of a large, for-profit NH chain, the Online Survey, Certification and Reporting (OSCAR) files, and the US Census tract data. In addition, we will compare disparities in these health conditions and management plans in residents of the proprietary set of NHs with those in a set of national for-profit and non-profit NHs using a fourth database of MDS records (without practitioner orders) and OSCAR, and Census data in a multi-level sensitivity analysis. In so doing, we will provide context to our findings and strengthen our ability to make more informed recommendations. Our study will provide the best evidence to date about which of the many possible modifiable factors associated with disparities in these outcomes should be targeted for intervention and ascertain the level of their contribution. Therefore, our findings are critical before interventions aimed at reducing disparities in incontinence and perineal skin damage can be undertaken or successful. PUBLIC HEALTH RELEVANCE: This is a study of differences in the involuntary leakage of urine and stool, associated skin damage, and quality of life that exist because of race, ethnic background, and social and economic status of older nursing home residents. This study will also examine nursing home and community factors that may play a role in the occurrence, prevention, and management of these health problems that greatly reduce physical and psychological well-being.