Pragmatic Clinical Trial to Improve Patient Experience Among Adults During Transitions from Hospital to Home: the PArTNER study.
Pragmatic Clinical Trial to Improve Patient Experience Among Adults During Transitions from Hospital to Home: the PArTNER study.
复制标题
改善成人从医院到家庭过渡期间患者体验的实用临床试验：PArTNER 研究。
DOI：
10.1007/s11606-022-07461-0
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发表时间：
2022
影响因子：
5.7
通讯作者：
Krishnan,JerryA
中科院分区：
文献类型：
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作者：
LaBedz,StephanieL;Prieto-Centurion,Valentin;Mutso,Amelia;Basu,Sanjib;Bracken,NinaE;Calhoun,ElizabethA;DiDomenico,RobertJ;Joo,Min;Pickard,ASimon;Pittendrigh,Barry;Williams,MarkV;Illendula,Sai;Krishnan,JerryA
IntroductionMinority-serving hospitals（MSHS）需要为他们所服务的人群量身定制的循证策略，以改善以患者为中心的结果后hospitalization.MethodsWe进行了一项务实的随机临床试验（RCT）从2014年10月至2017年1月在MSH比较的有效性，一个持牌人支持的导航器干预VS。社区卫生工作者和同伴教练提供的干预措施包括：（1）住院访视，以评估健康/医疗保健的障碍，并制定个性化的出院患者教育工具（DPET）;（2）家访，以审查DPET;（3）基于电话的同伴教练。共同主要结局是患者报告结局测量信息系统（PROMIS）焦虑和信息支持指标的30天变化的组间比较（最小重要差异为2至5个单位的变化）;使用意向治疗分析，ap值<0.025被认为是显著的。次要结果包括死亡，艾德访问，或再入院和情绪，社会和身体健康的措施，在30和60 days.ResultsWe招募了1029名成人住院心力衰竭（28%），肺炎（22%），心肌梗死（10%），慢性阻塞性肺病（11%），或镰状细胞病（29%）。超过80%是非西班牙裔黑人。总体而言，焦虑（校正差异：-1.6，97.5%CI-3.3至0.1，p =0.03）、信息支持（校正差异：-0.01，97.5%CI-2.0至1.9，p =0.99）或任何次要结局的30天变化无显著组间差异。探索性分析表明，Navigator干预改善了COPD患者、初级保健提供者、过去12个月内住院或基线焦虑较高的参与者的焦虑;在没有健康保险的参与者中，干预改善了信息支持结论：在MSH的这项实用RCT中，Navigator干预并没有改善医院后焦虑，信息支持，或其他结果相比，产妇护理。在参与者亚组中观察到的获益应在未来的研究中得到证实。试验RegistrationClinicaltrials.gov标识符：NCT 02114515
IntroductionMinority-serving hospitals (MSHs) need evidence-based strategies tailored to the populations they serve to improve patient-centered outcomes after hospitalization.MethodsWe conducted a pragmatic randomized clinical trial (RCT) from October 2014 to January 2017 at a MSH comparing the effectiveness of a stakeholder-supported Navigator intervention vs. Usual care on post-hospital patient experience, outcomes, and healthcare utilization. Community health workers and peer coaches delivered the intervention which included (1) in-hospital visits to assess barriers to health/healthcare and to develop a personalized Discharge Patient Education Tool (DPET); (2) a home visit to review the DPET; and (3) telephone-based peer coaching. The co-primary outcomes were between-group comparisons of 30-day changes in Patient-Reported Outcomes Measurement Information System (PROMIS) measures of anxiety and informational support (minimum important difference is 2 to 5 units change); ap-value <0.025 was considered significant using intention-to-treat analysis. Secondary outcomes included death, ED visits, or readmissions and measures of emotional, social, and physical health at 30 and 60 days.ResultsWe enrolled 1029 adults hospitalized with heart failure (28%), pneumonia (22%), MI (10%), COPD (11%), or sickle cell disease (29%). Over 80% were non-Hispanic Black. Overall, there were no significant between-group differences in the 30-day change in anxiety (adjusted difference: −1.6, 97.5% CI −3.3 to 0.1,p=0.03), informational support (adjusted difference: −0.01, 97.5% CI −2.0 to 1.9,p=0.99), or any secondary outcomes. Exploratory analyses suggested the Navigator intervention improved anxiety among participants with COPD, a primary care provider, a hospitalization in the past 12 months, or higher baseline anxiety; among participants without health insurance, the intervention improved informational support (allp-values <0.05).ConclusionsIn this pragmatic RCT at a MSH, the Navigator intervention did not improve post-hospital anxiety, informational support, or other outcomes compared to Usual care. Benefits observed in participant subgroups should be confirmed in future studies.Trial RegistrationClinicaltrials.gov identifier: NCT02114515