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

• 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
• 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

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.

急性护理医院每年出院超过150万败血症幸存者。败血症幸存者的几率是 非脓毒症患者在30天内再次入院，其中32%的再次入院发生在7天内， 天每年，超过三分之一的脓毒症幸存者在接受治疗后过渡到熟练的家庭医疗保健（HHC）。 住院治疗，护士监测再感染，支持不间断的药物管理，并工作 与患者、护理人员和其他提供者合作，以支持持续康复。这一拟议的竞争性更新是 基于我们先前研究（RO 1-NR 016014）生成的HHC最佳实践证据，显示了 注册护士的早期访问和早期门诊提供者的后续行动。我们发现30天的再住院 当脓毒症幸存者接受HHC护理时， 出院后2天内访视，第一周至少再访视1次，并接受门诊提供者随访 与未及时随访的患者相比，随访时间提前7天。然而，在全国范围内，只有28%的败血症幸存者 过渡到HHC的患者接受了该早期访视方案，因为实现该方案的几个障碍 存在.为了推进科学，拟议中的研究将测试这种做法在真实的中的有效性 世界和研究的实施与务实的，1型混合，逐步楔形随机试验 与急性和HHC利益攸关方结成伙伴关系。目标1：测试I- 在30天再住院和急诊使用中，与常规护理相比，转移干预 在接受家庭医疗的败血症幸存者中。阶梯楔形试验方案将包括一个基线期， 无干预，和两个步骤，其中随机二对提供干预。除了通常的 护理/控制期间，来自国家数据的额外幸存者将提供更大的 控制观察样本，加权以产生协变量平衡。将使用以下方法检验假设： 广义混合模型的协变量指导下的安德森卫生服务行为模型。在aim中 2我们将：产生有关背景、流程、战略和 实施I-TRANSFER的决定因素。实施目标以《综合行动计划》为指导， 实施研究框架。作为同类研究中规模最大的HHC， 通过实施科学的护理类型，拟议的研究有可能产生新的知识 关于向家庭健康过渡和家庭健康护理的过程。如果有效，在此期间干预的影响 共同的过渡进程可能是广泛的，改善不断增长的弱势人口的结果 脓毒症幸存者一个由各国专家组成的咨询小组将协助广泛传播 研究结果。