Effectiveness of a Mouth Care Program Provided by Nursing Home Staff vs Standard Care on Reducing Pneumonia Incidence: A Cluster Randomized Trial
| Autor: | Sheryl Zimmerman, Kimberly Ward, Sally C. Stearns, John S. Preisser, Christopher J. Wretman, Philip D. Sloane, Patricia Poole |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Health Knowledge Attitudes Practice Attitude of Health Personnel Health Personnel Rate ratio Oral hygiene law.invention Randomized controlled trial law Health care medicine North Carolina Humans Cluster randomised controlled trial Aged Original Investigation Aged 80 and over business.industry Incidence (epidemiology) Medical record Incidence Research General Medicine Pneumonia medicine.disease Oral Hygiene Nursing Homes Hospitalization Online Only Geriatrics Emergency medicine Female business |
| Zdroj: | JAMA Network Open |
| ISSN: | 2574-3805 |
| Popis: | Key Points Question Can nursing home staff reduce pneumonia by providing mouth care to residents? Findings In this pragmatic cluster randomized trial including 2152 residents from 14 paired nursing homes during 2 years, there was no statistically significant difference in the primary outcome of pneumonia incidence during 2 years. Adjusted post hoc analyses indicated a statistically significant reduction in pneumonia incidence during the first year. Meaning The results of this study suggest that it is possible for nursing home staff to reduce pneumonia, but doing so will require sustained efforts. This cluster randomized trial evaluates the effectiveness of Mouth Care Without a Battle, a program that increases staff knowledge and attitudes regarding oral hygiene, changes oral care, and improves oral hygiene, in reducing the incidence of pneumonia among nursing home residents. Importance Pneumonia affects more than 250 000 nursing home (NH) residents annually. A strategy to reduce pneumonia is to provide daily mouth care, especially to residents with dementia. Objective To evaluate the effectiveness of Mouth Care Without a Battle, a program that increases staff knowledge and attitudes regarding oral hygiene, changes mouth care, and improves oral hygiene, in reducing the incidence of pneumonia among NH residents. Design, Setting, and Participants This pragmatic cluster randomized trial observing 2152 NH residents for up to 2 years was conducted from September 2014 to May 2017. Data collectors were masked to study group. The study included 14 NHs from regions of North Carolina that evidenced proportionately high rehospitalization rates for pneumonia and long-term care residents. Nursing homes were pair matched and randomly assigned to intervention or control groups. Intervention Mouth Care Without a Battle is a standardized program that teaches that mouth care is health care, provides instruction on individualized techniques and products for mouth care, and trains caregivers to provide care to residents who are resistant and in special situations. The control condition was standard mouth care. Main Outcomes and Measures Pneumonia incidence (primary) and hospitalization and mortality (secondary), obtained from medical records. Results Overall, the study enrolled 2152 residents (mean [SD] age, 79.4 [12.4] years; 1281 [66.2%] women; 1180 [62.2%] white residents). Participants included 1219 residents (56.6%) in 7 intervention NHs and 933 residents (43.4%) in 7 control NHs. During the 2-year study period, the incidence rate of pneumonia per 1000 resident-days was 0.67 and 0.72 in the intervention and control NHs, respectively. Neither the primary (unadjusted) nor secondary (covariate-adjusted) analyses found a significant reduction in pneumonia due to Mouth Care Without a Battle during 2 years (unadjusted incidence rate ratio, 0.90; upper bound of 1-sided 95% CI, 1.24; P = .27; adjusted incidence rate ratio, 0.92; upper bound of 1-sided 95% CI, 1.27; P = .30). In the second year, the rate of pneumonia was nonsignificantly higher in intervention NHs. Adjusted post hoc analyses limited to the first year found a significant reduction in pneumonia incidence in intervention NHs (IRR, 0.69; upper bound of 1-sided 95% CI, 0.94; P = .03). Conclusions and Relevance This matched-pairs cluster randomized trial of a mouth care program compared with standard care was not effective in reducing pneumonia incidence at 2 years, although reduction was found during the first year. The lack of significant results in the second year may be associated with sustainability. Improving mouth care in US NHs may require the presence and support of dedicated oral care aides. Trial Registration ClinicalTrials.gov Identifier: NCT03817450 |
| Databáze: | OpenAIRE |
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