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

描述（由申请人提供）：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居民最常见的营养干预是口服液体营养补充剂，尽管补充剂在促进NH居民体重增加方面的有效性的对照证据有限。此外，研究表明，补充剂的提供与订单不一致，居民在日常NH护理实践中几乎没有得到工作人员的帮助，以促进消费。其结果是，营养风险的NH居民补充订单从补充剂中获得的额外每日卡路里很少。最近的证据有力地表明，每天在两餐之间多次为居民提供各种食物和液体的选择，再加上援助，可以有效地增加每日热量摄入和促进体重增加。然而，提供餐间选择干预需要更多的工作人员的时间相对于NH工作人员目前花费在餐间营养保健提供的时间。 一项新的联邦法规允许NHS培训非护理人员提供喂养援助护理。初步研究表明，受过“喂养助理”培训的非护理人员提供的进餐时间喂养援助护理与土著护士助理相当或更好。此外，最近的一个示范项目表明，这些工作人员可以有效地增强护士助理人员的能力，以便在日常护理实践中提供餐时喂养援助护理。拟议的转化研究将利用联邦法规培训非护理人员提供餐间营养护理。具体来说，拟议的研究将使用一个对照，干预设计，以确定成本效益的餐间选择干预相对于一个通常的护理控制组在一组200名居民在4个NH网站。接受热量补充的居民将被纳入本研究，并随机分为常规护理对照组或选择干预组（每组100名居民）。常规护理对照组将继续接受标准的NH护理，由土著护士助理人员提供餐间补充或零食。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，每天两次，每周五天，持续24周，同时还提供标准化的提示协议，以提高摄入量和饮食的独立性。研究人员将独立记录干预实施的成本，并将这些成本与有效性措施进行比较，包括热量摄入，体重和生活质量的改善。这些结果将由经过培训的研究人员使用标准化、经验证的方案在24周的研究期间对两组进行独立监测。这项转化研究工作将提供关键信息，以改善护理实践中的养老院营养风险的居民。

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.