TELE-TOC: Telehealth Education Leveraging Electronic Transitions Of Care for COPD Patients - Resubmission - 1

TELE-TOC：利用电子转换护理慢性阻塞性肺病患者的远程医疗教育 - 重新提交 - 1

• 批准号: 10293492
• 负责人: Joanna Abraham
• 金额: $ 40万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-10 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10293492
• 关键词: TELE; TOC; Telehealth; Education; Leveraging

PROJECT ABSTRACT Transitions of Care (TOC) for high-risk, frequently hospitalized adults with chronic diseases are complex, costly, and vulnerable to safety threats and poor health outcomes. Communication breakdowns, information lapses, and IT-induced unintended consequences can result in poor follow-up and medication non-adherence, both of which contribute to preventable readmissions or emergency room (ER) visits. The Transitional Care Model (TCM) aims to reduce such risks through a holistic, collaborative, patient-centered approach with in-home interventions. Prior to the SARS-CoV-2 pandemic and resulting coronavirus disease 2019 (COVID-19), most in- home interventions relied on in-person visits, which can be cost-prohibitive and unsustainable. One potential sustainable and scalable solution is to use telehealth for in-home virtual visits; however, use of telehealth for post-discharge TOC interventions has not been routinely implemented. In the post-COVID-19 era, given the rapid expansion of telehealth, hospitals are well-positioned to initiate this virtual care. In-home virtual visits may be particularly promising for patients with chronic obstructive pulmonary disease (COPD), who are often hospitalized, have multiple comorbidities, and require intensive medication teaching due to rampant inhaler misuse. COPD affects more than 16 million US adults, many of whom are older, contribute ~$50 billion to healthcare costs annually, experience high rates of acute care revisits, often due to care coordination failures. For this reason, Medicare’s Hospital Readmission Reduction Program (HRRP) aims to incentivize hospitals to implement TOC programs for increased quality and value of care for COPD patients. However, currently, such programs fall short of aligning with the full TCM. In-home interventions may be particularly salient for improving medication skills and outcomes for patients with COPD given rampant inhaler misuses, the effectiveness of in- hospital inhaler education, and evidence showing the need for inhaler education reinforcement post discharge. Thus, our trans-disciplinary team proposes to implement and evaluate “TELE-TOC: Telehealth Education: Leveraging Electronic Transitions Of Care for COPD patients,” which seeks to integrate virtual, pharmacy-based, in-home visits for COPD patients within our hospital’s existing COPD HRRP. Our central hypotheses are that virtual visits with pharmacists will be feasible to implement and will result in improved medication use and outcomes among COPD patients at high risk for readmission. We aim to iteratively design TELE-TOC using participatory study design and stakeholder input. We will then test the effectiveness of adding TELE-TOC virtual visits in a randomized controlled trial among COPD patients enrolled in our HRRP program. Lastly, we will develop a plan for a dissemination strategy and roadmap with national stakeholders to facilitate widescale adoption of TELE-TOC nationwide.

项目摘要 对于患有慢性病的高危、经常住院的成年人，过渡护理(TOC)是复杂、昂贵、 而且容易受到安全威胁和不良健康后果的影响。通讯中断，信息缺失， IT引发的意外后果可能会导致不良的随访和药物不遵守，两者都是 这有助于可预防的重新入院或急诊室(ER)就诊。过渡期护理模式 (中医)旨在通过以患者为中心的整体性、协作性的方法在家中降低此类风险 干预措施。在SARS-CoV-2大流行和由此导致的2019年冠状病毒病(新冠肺炎)之前，大多数人- 家庭干预依赖于面对面的访问，这可能是成本高昂且不可持续的。一种潜力 可持续和可扩展的解决方案是将远程医疗用于家庭虚拟访问；然而，将远程医疗用于 出院后TOC干预没有常规实施。在后新冠肺炎时代，鉴于 随着远程医疗的快速扩张，医院处于有利地位，可以启动这种虚拟医疗。家庭内虚拟访问可以 对于慢性阻塞性肺疾病(COPD)患者尤其有希望，他们经常 住院，有多种合并症，由于吸入器泛滥，需要强化用药教学 滥用。影响慢性阻塞性肺病的1600多万美国成年人，其中许多是老年人，贡献了约500亿美元 每年的医疗费用，经历了高急性护理复诊率，通常是由于护理协调失败。 因此，联邦医疗保险的医院再入院减少计划(HRRP)旨在激励医院 实施TOC计划，以提高COPD患者的护理质量和价值。但是，目前，这样的 这些项目未能与完整的中医课程保持一致。在改善方面，家庭干预可能尤为重要 严重滥用吸入器的慢性阻塞性肺疾病患者的用药技巧和结果，联合用药的有效性。 医院吸入器教育，并有证据表明出院后需要加强吸入器教育。 因此，我们的跨学科团队建议实施和评估“TELE-TOC：远程健康教育： 利用慢性阻塞性肺疾病患者的电子护理过渡“，旨在将虚拟的、基于药房的、 在医院现有的COPD HRRP范围内对COPD患者进行家庭访视。我们的中心假设是 与药剂师的虚拟访问将是可行的，并将导致改善药物使用和 再入院风险较高的COPD患者的预后。我们的目标是迭代地设计TELE-TOC，使用 参与性研究设计和利益相关者的意见。然后我们将测试添加TELE-TOC虚拟 在参加我们HRRP计划的COPD患者中进行的随机对照试验。最后，我们将 与国家利益攸关方共同制定传播战略和路线图计划，以促进广泛应用 在全国范围内采用TELE-TOC。