LEGTAP
Life Care Evidence-based Guidelines for Treating Nursing Home Acquired Pneumonia
Funded by: Agency for Healthcare Research and Quality
Project Period: 5/04 - 4/08
Abstract
Objective: (1) To determine whether the multifaceted,
multidisciplinary, national guideline-based protocol for treating Nursing Home
Acquired Pneumonia (NHAP) developed at a Health Maintenance Organization (HMO)
nursing home rounding service can be refined and implemented in the fee-for-service
sector. (2) To evaluate the effect of a guidelines-based protocol on hospitalization
and emergency department visit rates, cost of care, functional and cognitive ability and
health-related quality of life of subjects, hospital length of stay for patients requiring
hospitalization, and mortality.
Methods: This is a pre/post study with untreated control group.
We will collect baseline data on the care and outcomes of residents with NHAP in 16 Life
Care of America affiliated nursing homes in Colorado, Kansas, and Missouri, during one
influenza season (October through April). A multifaceted intervention implementing
guideline-based care in the eight Colorado nursing homes for two years will be compared
to usual care for NHAP at eight Kansas and Missouri nursing homes. The multifaceted
intervention, which includes (1) institutional change to facilitate immunization and
the availability of appropriate treatment and testing, (2) interactive educational
sessions to improve nursing assessment, and (3) academic detailing to physicians to
impact diagnostic and prescribing practices, has shown promising results in a pilot
test conducted in a single nursing facility on patients managed by a group model HMO.
Data pertaining to the primary outcome of guideline adherence and the secondary outcomes
of function, quality of life, and mortality will be obtained from nursing home charts,
direct observation, and nurse and aide care provider interviews. Utilization data will
be obtained from nursing home charts and Medicare Part A inpatient files, using subject
Medicare numbers. Because residents are clustered within facilities (i.e., multilevel
data), clustering effects will be taken into consideration using mixed models analysis.
Current Project Status: We are establishing databases and files,
finalizing instruments, and hiring nurse data collectors in Colorado, Kansas, and Missouri
for the baseline data collection year October 2004 - June 2005. Data collectors came to
the University of Colorado Denver for a four-day training in September
2004. They were taught direct entry of medical record review data into a customized MS
Access database. They learned how to interview residents using the quality of life
measure, the Reintegration to Normal Living Index, and use the Functional Improvement
Measure (FIM) to assess mobility. Instruction on conducting nurse interviews to assess
toilet transfer ability, using the FIM; confusion, using the Clinical Assessment of
Confusion tool; and Reintegration to Normal Living by proxy also was included. Meetings
with divisional headquarters are planned to describe the study to the Directors of
Nursing in the participating Life Care facilities.
Key Staff: Hutt, Kramer, Fish, Hartman, Liebrecht, Morley-Young. Radcliff, Linnebur, Ruscin,
Van Dorsten, Oman
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