Improving Care for Nursing Home Pneumonia in NHCUs and Veterans' Homes

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Department of Veterans Affairs
ClinicalTrials.gov Identifier:
NCT00120068
First received: July 1, 2005
Last updated: February 6, 2014
Last verified: February 2007

July 1, 2005
February 6, 2014
November 2004
March 2005   (final data collection date for primary outcome measure)
Not Provided
Not Provided
Complete list of historical versions of study NCT00120068 on ClinicalTrials.gov Archive Site
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Not Provided
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Improving Care for Nursing Home Pneumonia in NHCUs and Veterans' Homes
Improving Care for Nursing Home Pneumonia in NHCUs and Veterans' Homes

Nursing Home Acquired Pneumonia (NHAP) causes excessive morbidity, mortality, hospitalization, and loss of function. At any given time, 1.1-2.5% of veterans who reside at nursing home care units (NHCUs) and State Veterans Homes (SVHs) are ill with pneumonia. Multi-faceted implementation of evidence-based guidelines has been shown to be feasible in the private sector. Retrospective studies demonstrate an association between guideline adherence and improved survival.

Background:

Nursing Home Acquired Pneumonia (NHAP) causes excessive morbidity, mortality, hospitalization, and loss of function. At any given time, 1.1-2.5% of veterans who reside at nursing home care units (NHCUs) and State Veterans Homes (SVHs) are ill with pneumonia. Multi-faceted implementation of evidence-based guidelines has been shown to be feasible in the private sector. Retrospective studies demonstrate an association between guideline adherence and improved survival.

Objectives:

Assess the feasibility of a QUERI-like strategy to translate the guidelines into practice at VA-affiliated nursing homes through focus groups, interviews, and a small intervention trial.

Methods:

Nursing staff focus groups, key informant interviews, and tests of academic detailing (educational outreach) scripts were conducted at five facilities. Based on the information gathered, the QUERI-like intervention was modified and tested at the Florence, Colorado SVH during one influenza season compared to no intervention at a nearby SVH. Forty random SVH nursing staff took an anonymous telephone survey of knowledge and attitudes about NHAP twice prior to the intervention. A second randomly selected group of CNAs and nurses took the survey after the intervention. Research assistants enrolled residents with NHAP, interviewed them and their nurses about their quality of life, assessed their function and reviewed their medical records. The intervention was multifaceted, including (1) a formative phase to tailor implementation and foster staff investment in process and outcomes, (2) institutional level change to facilitate immunization and use of appropriate antibiotics and tests; (3) interactive educational sessions to improve nursing assessment; and (4) academic detailing to physicians to impact diagnostic and prescribing practices. Data were analyzed by Template Analysis Technique for qualitative data; test-retest reliability of the knowledge and attitude survey; exploratory bivariate comparison of intervention delivery and uptake, process of care and outcomes between the intervention and control facilities.

Status:

Project work is ongoing.

Interventional
Phase 2
Masking: Open Label
Primary Purpose: Prevention
Pneumonia
  • Behavioral: Nursing inservices
  • Procedure: Academic detailing to MDs; concurrent review and feedback
Arm 1
Interventions:
  • Behavioral: Nursing inservices
  • Procedure: Academic detailing to MDs; concurrent review and feedback

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
100
July 2005
March 2005   (final data collection date for primary outcome measure)

Inclusion Criteria:

Residents of Florence and Walsenburg, Colorado State Veterans Homes

Exclusion Criteria:

Residents within 48 hours of death or if in facility < 5 days

Both
18 Years and older
No
Contact information is only displayed when the study is recruiting subjects
United States
 
NCT00120068
IIR 03-123
No
Department of Veterans Affairs
Department of Veterans Affairs
Not Provided
Principal Investigator: Evelyn A. Hutt, MD Department of Veterans Affairs
Department of Veterans Affairs
February 2007

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP