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

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ClinicalTrials.gov Identifier: NCT00120068
Recruitment Status : Completed
First Posted : July 14, 2005
Last Update Posted : April 7, 2015
Sponsor:
Information provided by (Responsible Party):

Study Description
Brief Summary:
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.

Condition or disease Intervention/treatment Phase
Pneumonia Behavioral: Nursing inservices Procedure: Academic detailing to MDs; concurrent review and feedback Phase 2

Detailed Description:

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.


Study Design

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 100 participants
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: Improving Care for Nursing Home Pneumonia in NHCUs and Veterans' Homes
Study Start Date : November 2004
Primary Completion Date : March 2005
Study Completion Date : July 2005

Resource links provided by the National Library of Medicine

U.S. FDA Resources

Arms and Interventions

Arm Intervention/treatment
Arm 1 Behavioral: Nursing inservices Procedure: Academic detailing to MDs; concurrent review and feedback


Outcome Measures

Eligibility Criteria

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

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

Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00120068


Locations
United States, District of Columbia
VA Eastern Colorado Health Care System, Denver, CO
Denver, District of Columbia, United States, 80220
Sponsors and Collaborators
VA Office of Research and Development
Investigators
Principal Investigator: Evelyn A. Hutt, MD VA Eastern Colorado Health Care System, Denver, CO