Disparities in Infection in Home Health and Patients/Caregivers' Perceptions (Dis-Infection in HHC)

Home health care (HHC) is one of the largest and most rapidly growing health care sectors in the nation. HHC patients are at risk for healthcare associated infections (HAIs); socioeconomically disadvantaged HHC patients may be more prone to infections due to limited access to healthcare resources and presence of environmental hazards that increase infection risk. Only two studies have examined HHC patients' socioeconomic status (SES) and infection risk, and they are limited by the age of data, local scope of inquiry, and failure to measure the complex socio-economic composition of communities where HHC patients reside. Infection prevention and control (IPC) in HHC is prominent during the COVID-19 pandemic as HHC serves a vulnerable population. However, we found IPC is suboptimal in HHC and HHC clinicians reported that poor housing conditions and difficulties with patient/informal caregiver compliance with recommended practices pose specific challenges to IPC in HHC. Building upon our previous studies and guided by the Social-Ecological Model, we propose a 5- year, multi-site, mixed methods research study to address following aims: 1) examine socio-economic disparities in infection events, including COVID-19, among HHC patients before and during the COVID-19 pandemic; 2) describe IPC-related knowledge, attitudes, and practices among HHC patients (or informal caregivers) and examine associated factors; 3) explore IPC practices from the perspectives of HHC patients (or informal caregivers) and HHC provider; and 4) develop and pilot test a multi-modal intervention to improve knowledge and practice of IPC in HHC patients (or informal caregivers). We will merge multiple national datasets from 2019-2020 with the latest Area Deprivation Index (ADI) file, a multidimensional SES measure of neighborhoods, to study infection-related health disparities before and during the COVID-19 pandemic. We will study hospital transfers or emergency care visits due to four commonly reported HAIs in HHC (respiratory, urinary tract, wound and intravenous catheter-related) that occur 2 days after HHC admission as well as COVID-19 infections. Patients with high and very high risk of infection and/or their informal caregivers (n = 250) from two HHC agencies serving patients with diverse socioeconomic backgrounds in large geographic areas will be surveyed to understand their IPC-related knowledge, attitudes, practices and environmental risk factors. Using innovative dyadic interview analysis of both patient (or informal caregiver) and HHC provider interviews (40 pairs), we will better understand patient/caregivers' barriers to IPC and explore how best to enhance patient (or informal caregiver)-HHC provider interactions and improve IPC practices at home. Finally, we will triangulate the results from Aims 1-3 to develop a multimodal intervention to improve IPC knowledge and practices among HHC patients and informal caregivers, and pilot test it among 30 patients across all racial/ethnic and SES backgrounds. Conducted by a multi-disciplinary team, findings of this project will be used to guide future clinical IPC practices in HHC settings.