NHAP
Implementing Evidence-Based Guidelines for Treating Nursing Home Acquired Pneumonia

Funded by: AHRQ
Project Period: 5/04 - 4/08

Abstract

Nursing Home Acquired Pneumonia (NHAP) causes excess mortality, functional decline and hospitalization. At any given time, 1.1-2.5% of the country’s 2 million nursing home residents are ill with pneumonia. Many nursing home residents are not appropriately immunized, do not have their respiratory symptoms noted and acted upon expeditiously by nursing and attending physician staff, are not hospitalized appropriately, and do not receive appropriate antimicrobial therapy. Better care in several of these areas has been associated with survival of nursing home residents who acquired pneumonia. Evidence-based guidelines for evaluating and treating NHAP have been developed by a national multidisciplinary panel and published. Promising changes in processes of care were demonstrated during a pilot test of a multifaceted guideline implementation strategy that aligned immunization policies and emergency antibiotic supplies with the guidelines; provided quarterly in-service training for nursing home nurses and aides; and implemented an evaluation and treatment algorithm and standardized physician orders. Using a similar intervention strategy, this quasi-experimental study is designed to test the translation of these multidisciplinary guidelines into practice in multiple nursing facilities. Changes in adherence to the guidelines and outcomes (functional change, health-related quality of life, 30-day survival, and acute hospitalization utilization) will be examined after initiating the intervention in 8 private, for-profit facilities from a single nursing home corporation relative to usual care in 8 facilities from the same corporation. This pre-post test with untreated control group design will include prospective data collection for a total of 1,000 nursing home residents with incident pneumonia (250 pre-intervention; 250 post-intervention; 250 pre-comparison; and 250 post-comparison). Mixed effects models will be used to control for covariates and clustering effects.

Once the study is complete, findings will be disseminated by corporation-wide implementation of the guidelines using this multifaceted strategy; seeking professional society and trade association endorsement of the guidelines; and presentation to Centers for Medicare and Medicaid (CMS) relative to inclusion of guidelines in their nursing home quality improvement initiative.

Key Staff: Hutt, Liebrecht, Radcliff, Kramer, Fish, McNulty

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