Disparities in Infection in Home Health and Patients/Caregivers' Perceptions (Dis-Infection in HHC)

家庭医疗(HHC)是美国规模最大、增长最快的医疗保健部门之一。HHC 患者面临医疗保健相关感染(HAIs)的风险；社会经济状况不佳的HHC患者 由于获得医疗保健资源的机会有限以及环境的存在，可能更容易受到感染 增加感染风险的危险。只有两项研究检查了HHC患者的社会经济状况 (SE)和感染风险，而且它们受到数据年龄、当地查询范围和未能衡量的限制 HHC患者居住的社区的复杂社会经济构成。预防感染和 由于HHC服务于弱势人群，因此在新冠肺炎大流行期间，HHC的控制(IPC)非常重要。 然而，我们发现IPC在HHC中是次优的，HHC临床医生报告说，糟糕的住房条件和 患者/非正式照顾者遵守推荐做法的困难构成了以下具体挑战 HHC中的IPC。在前人研究的基础上，以社会-生态模型为指导，我们提出了一个5- 年、多地点、混合方法研究，以解决以下目标：1)审查社会经济 新冠肺炎患者在新冠肺炎前和新冠肺炎期间感染事件的差异 大流行；2)描述HHC患者中与IPC相关的知识、态度和做法(或非正式的 护理人员)和检查相关因素；3)从HHC患者的角度探讨IPC实践 (或非正式照顾者)和HHC提供者；以及4)开发和试点多模式干预以改善 HHC患者(或非正式照顾者)对IPC的认知和行为我们将合并多个国家 2019-2020年的数据集，包含最新的区域剥夺指数(ADI)文件，该文件是SES的多维衡量标准 以研究新冠肺炎大流行之前和期间与感染相关的健康差距。我们会 研究由于HHC中常见的四种HAI(呼吸系统， 尿路、伤口和静脉导管相关)发生在HHC入院后2天以及 新冠肺炎感染。感染风险高和极高的患者和/或他们的非正式照顾者(n= 250)来自两家HHC机构，为大地区不同社会经济背景的患者提供服务 将对这些地区进行调查，以了解其与IPC相关的知识、态度、做法和环境风险 各种因素。对患者(或非正式护理人员)和HHC提供者进行创新的二元访谈分析 访谈(40对)，我们将更好地了解患者/照顾者对IPC的障碍，并探索如何最好地 加强患者(或非正式护理人员)与HHC提供者之间的互动，并改进家庭中的IPC实践。最后， 我们将对目标1-3的结果进行三角测量，以开发多模式干预以提高IPC知识 并在HHC患者和非正式护理人员中进行实践，并在30名患者中进行试点测试 种族/民族和SES背景。由一个多学科的团队进行，这个项目的结果将被用于 指导未来HHC环境下的临床IPC实践。

Home health care (HHC) is one of the largest and most rapidly growing health care sectors in the nation. HHC patients are at risk for healthcare associated infections (HAIs); socioeconomically disadvantaged HHC patients may be more prone to infections due to limited access to healthcare resources and presence of environmental hazards that increase infection risk. Only two studies have examined HHC patients' socioeconomic status (SES) and infection risk, and they are limited by the age of data, local scope of inquiry, and failure to measure the complex socio-economic composition of communities where HHC patients reside. Infection prevention and control (IPC) in HHC is prominent during the COVID-19 pandemic as HHC serves a vulnerable population. However, we found IPC is suboptimal in HHC and HHC clinicians reported that poor housing conditions and difficulties with patient/informal caregiver compliance with recommended practices pose specific challenges to IPC in HHC. Building upon our previous studies and guided by the Social-Ecological Model, we propose a 5- year, multi-site, mixed methods research study to address following aims: 1) examine socio-economic disparities in infection events, including COVID-19, among HHC patients before and during the COVID-19 pandemic; 2) describe IPC-related knowledge, attitudes, and practices among HHC patients (or informal caregivers) and examine associated factors; 3) explore IPC practices from the perspectives of HHC patients (or informal caregivers) and HHC provider; and 4) develop and pilot test a multi-modal intervention to improve knowledge and practice of IPC in HHC patients (or informal caregivers). We will merge multiple national datasets from 2019-2020 with the latest Area Deprivation Index (ADI) file, a multidimensional SES measure of neighborhoods, to study infection-related health disparities before and during the COVID-19 pandemic. We will study hospital transfers or emergency care visits due to four commonly reported HAIs in HHC (respiratory, urinary tract, wound and intravenous catheter-related) that occur 2 days after HHC admission as well as COVID-19 infections. Patients with high and very high risk of infection and/or their informal caregivers (n = 250) from two HHC agencies serving patients with diverse socioeconomic backgrounds in large geographic areas will be surveyed to understand their IPC-related knowledge, attitudes, practices and environmental risk factors. Using innovative dyadic interview analysis of both patient (or informal caregiver) and HHC provider interviews (40 pairs), we will better understand patient/caregivers’ barriers to IPC and explore how best to enhance patient (or informal caregiver)-HHC provider interactions and improve IPC practices at home. Finally, we will triangulate the results from Aims 1-3 to develop a multimodal intervention to improve IPC knowledge and practices among HHC patients and informal caregivers, and pilot test it among 30 patients across all racial/ethnic and SES backgrounds. Conducted by a multi-disciplinary team, findings of this project will be used to guide future clinical IPC practices in HHC settings.