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养老院（NH）居民的一个常见问题，它可能导致营养不良、脱水、体重减轻、住院甚至死亡。对于有风险的NH居民来说，最常见的营养干预是口服液体营养补充剂，尽管有有限的控制证据表明补充剂在促进NH居民体重增加方面的功效。此外，研究表明，在日常NH护理实践中，补充剂的提供与订单不一致，居民几乎没有得到工作人员的帮助来促进消费。结果是，有营养风险的NH居民服用补充剂后，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，每天在两餐之间多次向居民提供各种食物和液体的选择，加上帮助，可以有效地增加每日卡路里摄入量，促进体重增加。然而，相对于NH员工目前花在餐间营养护理上的时间，提供餐间选择干预需要更多的工作人员时间。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，接受过“喂养助理”培训的非护理人员提供的餐时喂养辅助护理与当地护理人员相当或更好。此外，最近的一个示范项目表明，在日常护理实践中，这些人员可以有效地增加护士助理人员的用餐时间喂养辅助护理提供。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控制的干预设计来确定餐间选择干预相对于常规护理对照组的成本效益，在4个NH站点的200名居民中。有热量补充订单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，在两餐之间提供补充或零食，由土著护理人员提供。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独立性。研究人员将独立记录干预措施实施的成本，并将这些成本与包括改善热量摄入、体重和生活质量在内的有效性措施进行比较。这些结果将在24个研究周内由训练有素的研究人员使用标准化的、经过验证的方案对两组进行独立监测。这种转化研究的努力将提供关键信息，以改善护理实践在养老院的营养风险居民。

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.