SBIR-STTR Award

Clinical practice guidelines recommend implementation of nighttime incontinence care that minimizes sleep disruption for nursing home residents. However, these guidelines offer no specific intervention recommendations. Investigators propose a method to individualize incontinence care in the nighttime nursing home (NH) environment and seek to determine the feasibility of implementing this method. This will be accomplished through a clinical study in a NH using a pre and post intervention design where the intervention is the provision of incontinence care according to incontinence feedback data to NH staff using the incontinence care quality control (ICQC) system. Incontinence care during usual care (baseline, pre-intervention) will be compared to incontinence care during the intervention (use of the ICQC system). Response time to continence care, time required to provide incontinence care, and diaper changing frequency will be the major outcome measures. The Phase I goals are to: 1) demonstrate that providing ICQC data to NH staff results in more individualized incontinence care for NH residents, 2) document the staff resources necessary to implement the ICQC system, 3) document the costs of implementing the system, and 4) document family/resident willingness to pay for the system. The ICQC system electronically detects incontinence episodes, documents the resident's voiding patterns over time, and notifies NH staff of incontinence care needs. The majority of the technology has been previously developed with NIH funds. Minor modifications will be needed to adapt the existing system to the ICQC application. The utility of the ICQC system features (assessment and caregiver notification) in a daytime quality assessment and assurance program will be the focus of a Phase II study. The long- term goal of this research is to assess the efficacy of the ICQC to improve incontinence care in daytime and nighttime NH environments. Manufacturers of adult diapers with established distribution and marketing networks within the nursing home industry are likely partners for disseminating the proposed technology. The size, cost, and disposable nature of the wireless sensors facilitate their incorporation into the fabrication process.

Thesaurus Terms:
biomedical equipment development, biosensor, monitoring device, nursing home, urinary incontinence enuresis, medical record, miniature biomedical equipment, nursing research, portable biomedical equipment bioengineering /biomedical engineering, clinical research, human old age (65+), human subject

The disparity between the size of the frail, aging population and the nursing workforce that provides care for the elderly is growing, and will continue to expand at an alarming rate. Though the government and the public may demand that nursing homes provide high quality of care to elder residents, the current prospective payment system does not sufficiently reimburse facilities to hire and retain appropriate staffing levels. The correlation between a resident's quality of life and the amount of direct care time spent with nursing staff is well documented; however, without significant changes to the reimbursement system, residents should expect even less time devoted to direct care in the future. Incontinence is a condition for which many older adults are institutionalized. Staff time required to provide incontinence care is substantial. The proposed study will investigate the efficacy of a technology-assisted management of incontinence (TAMI) system that addresses three of the key quality indicators used to measure the quality of care provided by all nursing homes. Investigators hypothesize that use of the TAMI system will reduce the total time required to deliver incontinence care, while simultaneously improving individualized care. The overall potential benefits for residents, staff and management of nursing homes include improved quality of life for residents, higher staff productivity, and reduction in cost and suffering caused by skin breakdown related to time spent in wet conditions. Ultimately it is expected that nursing homes can utilize net savings in labor to further focus attention on other basic and preventive care processes. The proposed clinical study will be conducted in 3 nursing home facilities using a repeated measures design to determine if use of the proposed technology 1) incurs time savings in the provision of incontinence care, 2) reduces skin wetness upon change of briefs, 3) reduces incidence of blanchable erythema, 4) is consistently and effectively utilized when research staff are not present, 5) is cost effective from the perspective of facilities, and 6) results in perceived improvements in care for which families are willing to pay. The commercial potential for this process quality control system is discussed. Previous attempts to introduce similar technology into the nursing home facility have met resistance primarily due to the cost, unwieldy operation, and ineffectiveness. Moreover, the systems were not designed to meet the needs of the most critical element within the nursing home care process: the nurse aide. Incontinence is a condition for which many older adults are institutionalized and are labor intensive to prevent and to treat. We hypothesize that use of Technology Assisted Management of Incontinence: TAMi will reduce the total time required to deliver incontinence care through targeted intervention and that nursing homes can utilize the net savings in labor to attend to other basic and preventive care processes. The overall potential benefits of this time savings include improved quality of life, higher staff productivity, and potential cost savings resulting from avoidance of adverse outcomes.

Thesaurus Terms:
There Are No Thesaurus Terms On File For This Project.