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I-TRANSFER Improving TRansitions ANd outcomeS oF sEpsis suRvivors

I-TRANSFER 改善脓毒症幸存者的转变和结果

基本信息

批准号：
10347321
负责人：
Kathryn Helene Bowles
金额：
$ 63.67万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-09-25 至 2025-11-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10347321
关键词：
Accident and Emergency department Acute Address Attention Behavioral Model Care given by nurses Caregivers Caring Characteristics Clinical Code Communication Communities Consolidated Framework for Implementation Research Data Data Set Data Sources Diagnosis Discipline of Nursing Effectiveness Emergency department visit Equilibrium Evaluation Goals Guidelines Health Health Care Costs Health Personnel Health Professional Health Services Healthcare Industry Heart failure Home Home Care Services Home Health Agency Hospitalization Hospitals Hybrids Industry Inpatients Intervention Knowledge Length of Stay Medical Medicare Medicare claim Medication Management Medicine Modeling Monitor Morbidity - disease rate Myocardial Infarction Nurses Outcome Outpatients Patients Persons Pneumonia Population Process Professional Organizations Protocols documentation Provider Publishing Qualitative Methods Randomized Recovery Registered nurse Research Personnel Sampling Science Sepsis Site Survivors Talents Testing Time United States Visit Visiting Nurse Vulnerable Populations Work acute care base clinical research site cohort comparative effectiveness study comparison intervention cost design effectiveness testing experience follow-up health care service hospital readmission implementation barriers implementation determinants implementation science improved improved outcome innovation insight mortality prevent randomized trial readmission rates treatment as usual

项目摘要

Acute care hospitals discharge over 1.5 million sepsis survivors annually. Sepsis survivors are twice as likely as non-sepsis patients to be readmitted within 30 days, with 32% of those readmissions occurring within 7 days. Annually, over one third of sepsis survivors transition to skilled home health care (HHC) after their hospitalization where nurses monitor for reinfection, support uninterrupted medication management, and work with patients, caregivers, other providers to support continued recovery. This proposed competing renewal is based on HHC best practice evidence generated by our previous study (RO1-NR016014) showing the value of early visits by registered nurses and early outpatient provider follow-up. We found that 30-day rehospitalization rates were 7 percentage points lower (a 41% relative reduction) when sepsis survivors received a HHC nursing visit within 2 days of hospital discharge, at least 1 more visit the first week, and an outpatient provider follow-up visit by 7 days compared to those without timely follow-up. However, nationwide, only 28% of sepsis survivors who transitioned to HHC received this early visit protocol because several barriers to achieving this protocol exist. To advance the science, the proposed study will test the effectiveness of this practice in the real world and study the implementation with a pragmatic, Type 1 hybrid, stepped wedge randomized trial in partnership with dyads of acute and HHC stakeholders. Aim 1: Test the effectiveness of the I- TRANSFER intervention compared to usual care on 30-day rehospitalization and emergency department use among sepsis survivors receiving home health care. The stepped wedge protocol will involve a baseline period with no intervention, and two steps where randomized dyads provide the intervention. In addition to the usual care/control periods from the dyad sites, additional survivors from national data will provide a much larger sample of control observations, weighted to produce covariate balance. The hypotheses will be tested using generalized mixed models with covariates guided by the Anderson Behavioral Model of Health Services. In aim 2 we will: Produce insights and generalizable knowledge regarding the context, processes, strategies, and determinants of I-TRANSFER implementation. The implementation aim is guided by the Consolidated Framework for Implementation Research. As the largest HHC study of its kind and the first to transform this type of care through implementation science, the proposed study has the potential to produce new knowledge about the process of transition to and care in home health. If effective, the impact of this intervention during this common transition process could be widespread, improving the outcomes for a growing, vulnerable population of sepsis survivors. An Advisory Group of national experts will assist with widespread dissemination of the study results.

急症护理医院每年出院超过 150 万脓毒症幸存者。脓毒症幸存者的可能性是原来的两倍非败血症患者将在 30 天内重新入院，其中 32% 的再入院发生在 7 天内天。每年，超过三分之一的脓毒症幸存者在康复后过渡到熟练的家庭医疗保健 (HHC) 住院期间，护士监测再感染情况，支持不间断的药物管理和工作与患者、护理人员和其他提供者一起支持持续康复。这项拟议的竞争性更新是基于我们之前的研究 (RO1-NR016014) 生成的 HHC 最佳实践证据，显示了以下价值：注册护士的早期就诊和门诊服务提供者的早期随访。我们发现 30 天再住院当脓毒症幸存者接受 HHC 护理时，比率降低了 7 个百分点（相对降低 41%）出院后 2 天内就诊，第一周至少再就诊 1 次，并由门诊提供者进行随访与未及时随访的患者相比，随访时间缩短了 7 天。然而，在全国范围内，只有 28% 的败血症幸存者过渡到 HHC 的人收到了此早期访问协议，因为实现此协议存在一些障碍存在。为了推进科学发展，拟议的研究将在现实中测试这种做法的有效性世界并通过务实的 1 型混合阶梯式楔形随机试验研究实施情况与急性和 HHC 利益相关者合作。目标 1：测试 I- 的有效性转院干预与常规护理在 30 天再住院和急诊科使用方面的比较接受家庭医疗保健的败血症幸存者。阶梯式楔形协议将涉及基线期没有干预，以及随机二元组提供干预的两个步骤。除了平常的从二元站点的护理/控制期来看，国家数据中的更多幸存者将提供更大的数据控制观察样本，加权以产生协变量平衡。假设将使用以下方法进行检验具有由安德森健康服务行为模型指导的协变量的广义混合模型。瞄准目标 2 我们将：产生有关背景、流程、策略和内容的见解和通用知识 I-TRANSFER 实施的决定因素。实施目标以综合实施研究框架。作为同类中规模最大的 HHC 研究，也是第一个改变这一现状的研究通过实施科学的护理类型，拟议的研究有可能产生新知识关于家庭健康过渡和护理的过程。如果有效，这一干预措施在此期间的影响共同过渡进程可以广泛推广，改善不断增长的弱势群体的成果败血症幸存者。由国家专家组成的咨询小组将协助广泛传播研究结果。