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Tocchi, Corazzini, and PhD Student Vance Submit Applications for Research Grants

Thursday, March 9, 2017

Kudos to Christine Tocchi and her entire team for the submission of their NIH R15 application entitled "The Influence of Frailty on Home Healthcare Outcomes." This proposal requests funding for a two-year period with a start date of September 1, 2017.

Abstract: Medicare Home Healthcare (HHC) provides intermittent post-acute care to 3.5 million beneficiaries, most of whom are > 65 years, at a cost of 17.5 million dollars annually. Demand for HHC is expected to grow substantially as advances in medicine and technology support adults living longer with chronic illnesses, and home is the preferred post-acute setting for patients and families. Important HHC outcomes from an individual, clinical provider and policy perspective are re-hospitalization and institutionalization. These outcomes reflect the quality of HHC care, are associated with higher health care expenditures and are often preventable.

The limited HHC literature has identified several individual patient factors associated with poor health outcomes. However, discrete characteristics do not reflect the complexity of multiple factors that are often interdependent and additive in the older adult population. Frailty, a geriatric syndrome, is both complex and multifactorial and associated with poor health outcomes including re-hospitalization and institutionalization. However, there has been a dearth of research on the prevalence of frailty and the effects of frailty on health outcomes in HHC. This gap limits the key HHC providers, nurses from understanding and identifying older adult’s frailty status (non-frail, pre-frail, and frailty) and the use of frailty status in developing patient-specific interventions. Patient-specific interventions have shown improvement in frailty status, the prevention of further health status decline and the ability to promote positive health behaviors and independence. Frailty assessment and use of this information has the potential to improve the effectiveness of HHC

The proposed study will examine the prevalence of frailty in HHC and frailty’s association with the adverse health outcomes of re-hospitalization and institutionalization. This study will be a retrospective descriptive correlational study to examine if frailty status improves or is associated with re-hospitalization and institutionalization in HHC patients. Data will be collected from the Outcome Assessment and Information set (OASIS), a national data set used in the assessment and monitoring of health outcomes for all HHC patients. OASIS allows for the examination of the proportion of HHC patients with frailty and frailty’s influence on re-hospitalization and institutionalization.

Kudos to Kirsten Corazzini and Amy Vogelsmeier and their entire team for the submission of their NIH R15 Multi-PI application entitled "PRACTICE to Improve Quality of Care in Nursing Homes." This proposal requests funding for a two-year period with a start date of September 1, 2017.

Abstract: The majority of adverse health outcomes suffered by nursing home residents could be prevented through improved assessment and management of symptoms by nursing staff. However, in the nursing home, these core nursing practice activities are often interchangeably performed by RNs and LPNs, rather than through the collaborative efforts that build upon the strengths of each role. Therefore, we developed the Practical nurse, Registered nurse and Aide Collaborative Team In CarE (PRACTICE) intervention to address this root cause of adverse resident outcomes for effective nursing management of key symptoms of chronic conditions that often result in avoidable hospitalizations. PRACTICE is a series of innovative behavioral strategy sessions combining CONNECT, an empirically-tested intervention to improve the quality of connections among NH staff, and unfolding case studies focused on management of common conditions related to avoidable hospitalizations. PRACTICE is designed to influence unit-level RN, LPN, and nursing assistant (NA) teams to accomplish care in ways that more appropriately and fully use the different scopes of RN and LPN practice improve resident health outcomes. Feasibility of PRACTICE was established in a recent pilot.

This 2-year study will be conducted in four corporate-owned NHs with the purpose of refining measures of adherence and estimating intervention effect sizes. Each NH will be randomized to a treatment (PRACTICE) or control group. Specific aims are to: 1) refine measures of adherence by nursing staff to the intervention; 2) examine preliminary effects of the intervention on measures of RN-LPN-NA care collaboration and trajectories of resident care outcomes of common conditions of avoidable hospitalizations, including congestive heart failure, urinary tract infections, and aspiration pneumonitis; and 3) estimate effect sizes of the intervention on potentially avoidable hospitalizations of residents.

Kudos to PhD student Ashlee Vance and her advisors for the submission of her NANN application entitled "Trajectory of Parenting Confidence Among Parents of Infants with Complex Chronic Conditions." This proposal requests funds for a one-year period with a start date of April 1, 2017.

Abstract: Infants with complex chronic conditions (I-CCCs) have substantial caregiving needs and high healthcare utilization. Parents of I-CCCs  evelop confidence and learn how to parent their infant within the hospital environment. Parenting confidence (PC) is defined as a parent’s belief about their ability to be successful in their parenting role. Contextual factors like family centered care, family functioning, and infant caregiving complexity are hypothesized to foster the development of PC. The purpose of this study is to understand parent trajectories of confidence and the influence of contextual factors on the development of parent confidence over time.

The new knowledge gained from this study will further our awareness about the multifaceted needs of parents who have infants requiring specialized medical care. A confident parent is fundamental to the long-term health and development of I-CCCs. Understanding how confidence develops and the influence of contextual factors will allow both clinicians and researchers to develop strategies and support parents in developing confidence.