Denver VA Medical Center, CO 80220, USA.
J Am Med Dir Assoc. 2011 Sep;12(7):499-507. doi: 10.1016/j.jamda.2010.03.011. Epub 2010 Oct 2.
Determine whether a comprehensive approach to implementing national consensus guidelines for nursing home-acquired pneumonia (NHAP) affected hospitalization rates.
Quasi-experimental, mixed-methods, multifaceted, unblinded intervention trial.
Sixteen nursing homes (NHs) from 1 corporation: 8 in metropolitan Denver, CO; 8 in Kansas and Missouri during 3 influenza seasons, October to April 2004 to 2007.
Residents with 2 or more signs and symptoms of systemic lower respiratory tract infection (LRTI); NH staff and physicians were eligible.
Multifaceted, including academic detailing to clinicians, within-facility nurse change agent, financial incentives, and nursing education.
Subjects' NH medical records were reviewed for resident characteristics, disease severity, and care processes. Bivariate analysis compared hospitalization rates for subjects with stable and unstable vital signs between intervention and control NHs and time periods. Qualitative interviews were analyzed using content coding.
Hospitalization rates for stable residents in both NH groups remained low throughout the study. Few critically ill subjects in the intervention NHs were hospitalized in either the baseline or intervention period. In control NHs, 8.7% of subjects with unstable vital signs were hospitalized during the baseline and 33% in intervention year 2, but the difference was not statistically significant (P = .10). Interviews with nursing staff and leadership confirmed there were significant pressures for, and enablers of, avoiding hospitalization for treatment of acute infections.
Secular pressures to avoid hospitalization and the challenges of reaching NH physicians via academic detailing are likely responsible for the lack of intervention effect on hospitalization rates for critically ill NH residents.
确定实施养老院获得性肺炎（NHAP）国家共识指南的综合方法是否会影响住院率。
准实验、混合方法、多方面、非盲干预试验。
来自 1 家公司的 16 家养老院（NH）：科罗拉多州丹佛市的 8 家；堪萨斯州和密苏里州的 8 家，在 2004 年至 2007 年的 3 个流感季节，10 月至 4 月。
有 2 个或更多全身下呼吸道感染（LRTI）体征和症状的居民；NH 工作人员和医生符合条件。
多方面的，包括向临床医生提供学术详细信息、院内护士变革推动者、财务激励措施和护理教育。
对受试者的 NH 病历进行审查，以了解居民特征、疾病严重程度和护理过程。对干预和对照 NH 以及时间期间稳定和不稳定生命体征受试者的住院率进行了双变量分析。使用内容编码对定性访谈进行了分析。
在整个研究过程中，两组稳定居民的住院率都很低。在干预 NH 中，很少有重症患者住院，无论是在基线还是干预期。在对照 NH 中，8.7%生命体征不稳定的受试者在基线期住院，33%在干预年 2 期住院，但差异无统计学意义（P=.10）。对护理人员和领导层的访谈证实，存在避免住院治疗急性感染的巨大压力和促进因素。
避免住院的长期压力和通过学术详细信息接触 NH 医生的挑战可能是导致对重症 NH 居民住院率没有干预效果的原因。
