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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.

急诊医院每年让150多万败血症幸存者出院。败血症幸存者的可能性是前者的两倍