The Virtual Mentored Implementation to Reduce REVISITS (Reducing Respiratory Emergent Visits using Implementation Science Interventions Tailored to Setting) Study

项目摘要 慢性阻塞性肺疾病（COPD）影响着1600万美国成年人，其中许多人患有高血压。 由于护理转换导致的首次住院后急诊科和医院COPD复诊率 失败这些频繁的COPD急性加重导致更快的肺功能下降和更早的死亡。 此外，急性加重的住院治疗在很大程度上贡献了每年用于COPD护理的约500亿美元， 美方因此，COPD复发现在是一个公共卫生危机。改善COPD护理和 减少急性护理复诊，如已发表的成功护理过渡干预措施的证据所示。我们 一个小组领导了确定有效的护理过渡干预措施的工作，并成功地试行了一个多层次的 COPD护理过渡计划。有效的护理过渡干预措施包括药物协调，自我护理， 管理教育和出院后的沟通。然而，为了广泛采用，我们 必须根据医院的资源和病人的护理需要确定最佳的干预提供方法。为 例如，虚拟支持的干预措施往往更节省资源， 个别虚拟干预存在，多层次的虚拟程序尚未研究相比， 个人节目。此外，还需要采取可行的执行办法，支持提供循证的 护理过渡方案需要广泛传播和可持续性。我们的团队发现， 一个指导实施模式是有效的实施多层次，以医院为基础的计划在美国各地 卫生系统。这种方法传统上依赖于现场访问。使用虚拟网站访问可以 大大增加了这种模式的影响范围，但尚未被研究。总而言之，为了成功，大规模的 采用，不同的美国医院需要获得可行的，多层次的护理过渡计划， 与特定地点的护理需求和资源相一致的有效实施方法，但目前 最佳方法是未知的。因此，在本提案中，我们将比较虚拟与内部的有效性- 在现实世界中，通过同时研究 虚拟或亲自指导的实施增加了方案的覆盖面。我们将与医院合作 医学再工程网络召开了快速发现和传播，以确定和注册网站。 在所有地点使用综合框架进行实施前背景评估后， 实施研究，我们将进行混合II型可靠性-实施研究，以确定 减少30天COPD复查的计划的有效性和指导实施的有效性， 程序渗透。最后，我们将研究项目实施后两年的持续成果。 本研究的数据将为COPD护理过渡计划的最佳实施提供信息。此外，本发明还 从这项研究中获得的经验教训可以为其他医院项目的实施方法提供信息。

PROJECT SUMMARY Chronic Obstructive Pulmonary Disease (COPD) affects 16 million US adults, many of whom experience high rates of emergency department and hospital COPD revisits after initial hospitalizations due to care transition failures. These frequent COPD exacerbations lead to more rapid lung function decline and earlier mortality. Further, hospitalizations for exacerbations highly contribute to the ~$50 billion spent annually for COPD care in the US. Therefore, COPD revisits are now a public health crisis. It is feasible to improve COPD care and decrease acute care revisits, as shown by published evidence of successful care transition interventions. Our team has led efforts to identify effective care transition interventions and has successfully piloted a multi-level COPD care transition program. Effective care transition interventions include medication reconciliation, self- management education, and post-discharge communication. However, for wide-spread adoption to occur, we must identify optimal intervention delivery methods based on hospitals' resources and patient care needs. For instance, virtually-supported interventions are often more resource-friendly, and while effectiveness data on individual virtual interventions exists, multi-level virtual programs have not yet been studied compared to in- person programs. In addition, feasible implementation approaches to support the delivery of evidence-based care transition programs are needed for wide-scaled dissemination and sustainability. Our team has found that a mentored implementation model is effective for implementing multi-level, hospital-based programs across US health systems. This approach traditionally relies on in-person site visits. The use of virtual site visits could dramatically increase this model's reach, but has not yet been studied. In summary, for successful, wide-scale adoption, diverse US hospitals need to have access to feasible, multi-level care transition programs and effective implementation approaches that are aligned with site-specific care needs and resources, but currently the optimal approach is unknown. Thus, in this proposal, we will compare the effectiveness of virtual vs. in- person multi-level COPD care transition programs in real-world settings by concurrently studying whether virtual or in-person mentored implementation increases programs' reach. We will collaborate with the Hospital Medicine Reengineering Network convened for rapid discovery and dissemination to identify and enroll sites. After conducting pre-implementation contextual assessments at all sites using the Consolidated Framework for Implementation Research, we will conduct a Hybrid Type II Effectiveness-Implementation study to determine effectiveness of the programs to reduce 30-day COPD revisits and of the mentored implementation to increase program penetration. Finally, we will study programs' sustained outcomes for two years post-implementation. Data from this study will inform the optimal implementation of COPD care transition programs at scale. Further, lessons gleaned from this study can inform implementation approaches for other hospital-based programs.