Intervention Planning to Reduce Nursing Home Pneumonia

Quagliarello, Vincent

Abstract

The overarching goal of this proposal is to spend one year to plan for an eventual clinical trial in which a multicomponent intervention will be tested for its effectiveness in reducing the rate of pneumonia in elderly nursing home residents. Given the complexity of investigating a multi-component intervention among vulnerable nursing home residents, this planning year is needed to accomplish the specific aims before pursuing the clinical trial.
The specific aims of this 1-year planning proposal are: 1. To pilot test the feasibility of, and staff adherence to, intervention options for three modifiable risk factors for nursing home acquired pneumonia (i.e., poor oral hygiene, swallowing difficulty, lack of S. pneumoniae and influenza vaccination), and assess preliminary evidence that the interventions reduce the risk factors in the nursing home setting. 2. To select among the intervention options and create a multi-component intervention protocol for the eventual clinical trial, based on the results of the pilot testing. 3. To finalize the design (i.e., final randomization strategy, sample size estimate, plans for interim and final analysis), setting (i.e., nursing home facility sites) and project organization (i.e., data safety monitoring and coordination, personnel resources, budget, and Manual of Procedures) for the eventual clinical trial. The primary hypothesis of the eventual clinical trial is that nursing home-acquired pneumonia is a multi-factorial geriatric syndrome with modifiable risk factors each contributing modest risk, and that a multi-component intervention protocol targeted to the modifiable risk factors will reduce the rate of pneumonia outcome, compared to usual care. This proposal utilizes the resources of the Claude D. Pepper Older Americans Independence Center at Yale University School of Medicine, which has documented experience in conducting successful clinical trials of multi-component interventions in other geriatric syndromes with multi-factorial modifiable risk factors. Pneumonia is the leading cause of death in elderly nursing home residents, and it results in considerable morbidity, functional decline, and healthcare expenditures since it is a major cause of transfer to acute care facilities. A feasible and effective intervention for pneumonia prevention will hold great promise in reducing clinical morbidity and costs among this vulnerable population of citizens.