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。败血症幸存者的可能性是由于非杰出患者将在30天内重新入学，其中32％发生在7天内天。每年，超过三分之一的败血症幸存者过渡到熟练的家庭医疗保健（HHC）护士监视重新感染，支持不间断的药物管理和工作的住院治疗与患者，看护人，其他提供者一起支持持续康复。这个拟议的竞争更新是基于我们先前研究（RO1-NR016014）产生的HHC最佳实践证据注册护士和早期门诊提供者随访的早期访问。我们发现30天的重新住院当败血症幸存者接受HHC护理时，率降低了7个百分点（相对降低41％）在出院后的2天内访问，至少在第一周再访问1次，以及门诊提供者随访与没有及时随访的人相比，访问7天。但是，在全国范围内，只有28％的败血症幸存者过渡到HHC的人获得了此早期访问协议，因为实现此协议的几个障碍存在。为了推进科学，拟议的研究将在实际的世界并使用务实的1型混合动力，阶梯楔随机试验来研究实施与急性和HHC利益相关者的二元组合作。目标1：测试I-的有效性转移干预与30天的重新住院和急诊科的常规护理相比在接受家庭保健的败血症幸存者中。步进楔形协议将涉及基线周期没有干预，并且有两个步骤随机二元组提供干预。除了通常来自Dyad站点的护理/控制期，来自国家数据的其他幸存者将为更大对照观察的样本，加权以产生协变量平衡。假设将使用由安德森卫生服务行为模型指导的协变量的广义混合模型。目标 2我们将：关于上下文，过程，策略以及 I-Transfer实施的决定因素。实施目标由合并的指导实施研究框架。作为同类HHC最大的研究，也是第一个改变这一点的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在家庭健康中过渡和护理的过程。如果有效，则在此期间对这种干预的影响共同的过渡过程可能是普遍的，改善了成长中的脆弱人群的结果败血症幸存者。一个国家专家的咨询小组将协助广泛传播研究结果。