VA-NHAP
Improving Care for Nursing Home Pneumonia in NHCUs and Veteran’s Homes
Funded by: National Cancer Institute
Project Period: 8/04 - 9/05
Abstract
Objectives: 1) Conduct the formative analysis necessary to implement the Nursing
Home Acquired Pneumonia (NHAP) guidelines in a variety of VA-affiliated nursing homes;
(2) ascertain that our measurements of nursing staff knowledge and attitudes, intervention
uptake, and proxy assessment of health-related quality of life are useful and reliable;
and (3) collect process of care and outcome data during the intervention to finalize the
methods and estimate sample size requirements for a larger study. Successful completion
of this study will allow us to submit a proposal to Veterans Administration Health Services
and Research Department (VA-HSR&D) in December 2004 to proceed with a statewide, multidisciplinary,
intervention study, parallel to the private sector study currently funded by the Agency for
Healthcare Research and Quality (AHRQ), implementing national evidence-based guidelines for
evaluating and treating NHAP at VA Nursing Home Care Units (NHCUs) and State Veterans Homes
(SVHs) in Colorado, contrasted with usual care in Missouri.
Methods: This study will be conducted in two phases, a formative phase and an
implementation phase. The formative phase, including focus groups, key informant interviews,
meetings with physicians to pilot-test academic detailing, and reliability testing of the nursing
staff knowledge and attitude survey, will be conducted at the Grand Junction, Colorado NHCU and
SVH in New Mexico and Arizona. The implementation phase will test the multifaceted intervention
in the Florence, Colorado SVH, compared with usual care in the Walsenburg, Colorado SVH, both
located in Southern Colorado, during the upcoming influenza season. The multifaceted intervention
includes (1) formative meetings and interviews, (2) institutional level change to facilitate
immunization and the availability of appropriate antibiotics and diagnostic testing,
(3) interactive educational sessions to improve nursing assessment, and (4) academic detailing to
physicians to impact diagnostic and prescribing practices. Intervention uptake will be measured
qualitatively and quantitatively. The quantitative measure combines the intervention dose
delivered to the facility, measured as the amount of time spent by facility personnel in contact
with the research team, and the intervention dose taken up by the facility, measured by
vaccination variables, staff participation variables, materials variables and a pre- and
post-intervention nursing staff knowledge and attitude survey. To assess sample size requirements
for a larger study, 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 at the two Southern
Colorado SVHs.
Current Project Status: A nurse data collector is being hired and will be trained with
the data collectors in the private sector study. Planning for the formative phase of the study
is underway; it began in August 2004. The intervention in the Florence SVH and data collection
in both Southern Colorado SVHs will begin in October 2004. The study will be complete in
September 2005.
Key Staff: Hutt, Kramer, Fish, Hartman, Liebrecht, Radcliff, Ruscin, Corbett, Bent, Williams
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