# Study of Infection Management and Palliative Care at End-of-Life (SIMP-EL)

> **NIH NIH R01** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2020 · $682,147

## Abstract

Excellence in palliative care is a priority in the nursing home (NH) setting, which provides care to many older
residents with advanced illness at the end of life. Unfortunately, suboptimal palliative care is common.
Infections are a frequent occurrence and management is challenging for many reasons. In our successful
parent study we focused on infection control and management programs in NHs across the nation and found
that annually 40% of all Medicare-certified NHs receive deficiency citations for inadequate infection control and
less than half of NHs (46%) had written guidelines for antibiotic initiation. Antibiotics account for approximately
40% of all medications administered in NHs. Unfortunately, much of the use is inappropriate as antibiotics are
often initiated in the absence of clinical evidence of a bacterial infection, and this misuse is a major risk factor
for multidrug-resistant organisms and Clostridium difficile infections. Suspected infections are common reasons
for elderly resident transfers to hospitals, and these are burdensome and often not clinically beneficial. For the
majority of NH residents, the risks and suffering associated with antibiotic use and hospital transfer due to
infection may outweigh the benefit. In addition, the infection control and management as well as the palliative
care landscapes are changing in NHs with various regional and state level initiatives being implemented. It is
likely that for some NHs these initiatives will promote resident-centered care that integrates infection
management and palliative care while in others, NH personnel will be held to standards that favor burdensome
curative treatments. In our competing renewal, we will use longitudinal Minimum Data Set data and Medicare
files (i.e., approximately 1 million residents over years 2011 to 2017) to identify elderly NH residents and
important resident level covariates (e.g., advanced illness), track antibiotic and hospice use, and track hospital
transfers related to infections. We will complement and link these secondary datasets with environmental
scans of state and regional activities as well as with data from a national survey of new NHs and our “core”
NHs surveyed in 2014 as part of our parent study (we estimate that 1,500 NHs will respond). The survey will
characterize implementation of current recommended structures and processes related to: 1) infection control
and management, 2) palliative care, and 3) the integration of infection management and palliative care. Our
specific aims are to: 1) Describe the integration of infection management and palliative care in NHs and the
associated facility, state, and regional characteristics; 2) Examine factors associated with antibiotic use in
elderly NH residents; and 3) Examine factors associated with hospital transfer due to infections among elderly
NH residents. Understanding how best to improve the integration of infection management and palliative care
to improve residents' quality of li...

## Key facts

- **NIH application ID:** 9893907
- **Project number:** 5R01NR013687-08
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Patricia W. Stone
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $682,147
- **Award type:** 5
- **Project period:** 2012-07-01 → 2022-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9893907

## Citation

> US National Institutes of Health, RePORTER application 9893907, Study of Infection Management and Palliative Care at End-of-Life (SIMP-EL) (5R01NR013687-08). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9893907. Licensed CC0.

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