Nursing Home Acquired Pneumonia (NHAP) causes excessive morbidity, mortality, hospitalization, and loss of function. At any given time, 1.1-2.5% of veterans who reside at nursing home care units (NHCUs) and State Veterans Homes (SVHs) are ill with pneumonia. Multi-faceted implementation of evidence-based guidelines has been shown to be feasible in the private sector. Retrospective studies demonstrate an association between guideline adherence and improved survival. This study assessed the feasibility of a Quality Enhancement Research Initiative (QUERI)-like strategy to translate the guidelines into practice at VA-affiliated nursing homes through focus groups, interviews, and a small intervention trial. Mixed methods, such as nursing staff focus groups, key informant interviews, and tests of academic detailing (educational outreach) scripts were conducted at five facilities. Based on the information gathered, the QUERI-like intervention was modified and tested at the Florence, Colorado SVH during one influenza season compared to no intervention at the Walsenburg, Colorado SVH. Forty randomly chosen SVH nursing staff took an anonymous telephone survey of knowledge and attitudes about NHAP twice prior to the intervention. A second randomly selected group of certified nurse assistants (CNAs) and licensed nurses took a follow-up survey after the intervention. Research assistants consented and enrolled residents with NHAP, interviewed them and their nurses about their quality of life, assessed their function and reviewed their medical records for compliance with the guidelines.

Intervention: Multifaceted, including (1) a formative phase to tailor guideline implementation and foster staff investment in process and outcomes, (2) institutional level change to facilitate immunization and the availability of appropriate antibiotics and diagnostic testing; (3) interactive educational sessions to improve nursing assessment; and (4) academic detailing to physicians to impact diagnostic and prescribing practices.

Principal Types of Analyses: Template Analysis Technique for qualitative data; test-retest reliability of the knowledge and attitude survey; exploratory bivariate comparison of intervention delivery and uptake, process of care and outcomes between the intervention and control facilities

• Residents of Florence and Walsenburg, Colorado State Veterans Homes