# Infection Prevention in Home Health Care (InHOME)

> **NIH NIH R01** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2020 · $578,596

## Abstract

Many older patients at risk for infections are receiving home healthcare (HHC) services. In a systematic review
we found little is known about infections occurring while patients are enrolled in HHC and how best to mitigate
infection risk for these vulnerable patients. In pilot work (R03 NR013966), using 2010 national Outcome and
Assessment Information Set (OASIS) data, we have found infections to be a common reason for unplanned
hospitalizations among HHC patients. However, OASIS data are limited and likely underestimate the true
infection rate. We also found agency-level infection rates varied greatly across the country. The variation
across agencies may indicate that recommended guidelines are not being adopted and/or that there are
limitations in the guidelines themselves. The HHC environment is the fastest growing healthcare sector in the
nation but is less controlled than other settings, is increasing in complexity with patients being discharged from
hospitals earlier, and care is often provided by patients, family members, or personal aides with little or no
formal training in infection prevention. Informed by our systematic review, pilot work, and Andersen's
Behavioral Model for Vulnerable Populations, we propose a 4-year, multiple methods study with the following
aims: 1) describe the incidence of infections that occur while patients are receiving HHC and the relationship
with patients' predisposing, enabling, and need characteristics; 2) describe the current infection prevention and
control infrastructure and policies in HHC agencies; 3) compare the effectiveness of various infection
prevention and control infrastructures and policies in preventing infections in HHC; and 4)
estimate survival
and healthcare utilization associated with infections in HHC patients
. In Aim 1, we will use the most current
(2013-2015) administrative data (e.g., OASIS and Medicare claims) from 3,333 randomly sampled agencies.
In Aim 2, qualitative in-depth, open-ended interviews will be conducted in 12 HHC agencies across the nation
to inform the phenomena of infection prevention, refinement of our survey, and Aims 3 and 4. Then, we will
survey HHC agencies (expected sample n = 1,333). For Aim 3, we will link the survey data with concurrent
patient (n = 133,300) and agency (n = 1,333) data. For Aim 4, we will use longitudinal data (2013-2017) on up
to 1 million patients. The econometric analyses will address patients nested within HHC agencies, assess
individual risk, and minimize threats to validity. Our multidisciplinary research team is ideally qualified to
conduct this study, which will be the first of its kind in HHC. Focusing on infection prevention and control efforts
in HHC across the nation is innovative and will extend the infection prevention research paradigm. Results will
be seminal in the HHC setting, and evidence developed from this project will inform authors of future practice
guidelines, clinicians, managers, and policy makers on the problem ...

## Key facts

- **NIH application ID:** 9970273
- **Project number:** 5R01NR016865-04
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Jingjing Shang
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $578,596
- **Award type:** 5
- **Project period:** 2017-09-21 → 2022-04-17

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9970273

## Citation

> US National Institutes of Health, RePORTER application 9970273, Infection Prevention in Home Health Care (InHOME) (5R01NR016865-04). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9970273. Licensed CC0.

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