Disparities in Incontinence and Perineal Skin Damage in Nursing Home Elders

描述(由申请人提供)：这是一项关于种族、民族和社会经济(SES)差异的研究，因为它们与老年疗养院(NH)居民的大小便失禁、会阴皮炎(PD)、压疮(PU)和相关的生活质量的发展和管理有关。有关大小便失禁和会阴皮肤损伤的差异及其处理的报道是一个严重的伦理和临床问题，值得进一步调查。大小便失禁、脓肿和帕金森病是长期存在的、广泛存在的、代价高昂的问题，种族、民族和社会经济地位的差异可能会对这些问题产生重大影响。每年的治疗费用高达数十亿美元，每种情况都与心理痛苦、身体不适和生活质量下降密切相关。脓液的并发症可能是致命的。缩小健康差距为改善弱势少数群体的健康提供了深刻的机会。由于NH居民的健康结果以及这些结果之间的差异在NH住院之前和期间受到个人、群体和社区层面的多种因素的影响，因此调查他们的贡献需要多层次的方法。以前的研究主要集中在个人层面的居民特征或只控制几个NH因素；没有人使用多层次、多因素的方法。由于我们的数据集，我们能够同时测量个人、NH和社区层面的因素，这些因素与大便和/或尿失禁、PD、脓液和相关生活质量的发展、预防和管理方面的差异有关。我们将分析三个大型人口数据集：大型营利性NH链中所有居民的最低数据集(MDS)记录和从业者订单、在线调查、认证和报告(OSCAR)文件，以及美国人口普查区域数据。此外，我们将使用第四个MDS记录数据库(没有从业者订单)和OSCAR，以及多级敏感性分析中的人口普查数据，比较专有NHS与国家营利性和非营利性NHS的居民在这些健康状况和管理计划方面的差异。通过这样做，我们将为我们的调查结果提供背景，并加强我们提出更有见地的建议的能力。我们的研究将提供迄今为止最好的证据，说明与这些结果的差异相关的许多可能的可修改因素中，哪些应该作为干预的目标，并确定它们的贡献水平。因此，在采取或成功采取旨在减少大小便失禁和会阴皮肤损伤差异的干预措施之前，我们的发现是至关重要的。

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.