Personalized Clinical Decision Support to Improve Participation in Hospital at Home

项目摘要 住院治疗是昂贵的-占1.1万亿美元的医疗保健支出每年在美国 国家-并与高发病率和死亡率的风险。家庭医院（HaH）是一种替代方案 护理模式，其中护理团队在患者家中提供急性医院级护理。尽管有几十年的数据 支持与以患者为中心的关键结局相关的HaH疗效，HaH参与的障碍限制了其 广泛采用和人口健康影响。我们的中心假设是， 需要临床决策支持（CDS）集成来自不同来源的数据和共享决策 (SDM)框架，以帮助告知有关HaH的护理点决策，并克服低参与率。 我们工作的首要目标是通过帮助患者参与决策， 哪种急性护理方案最能满足他们的需求。本研究的目的是评估是否 健康信息技术（IT）支持的SDM解决方案，包含预期的患者结果和 偏好并部署在护理点，提高了患者和提供者对HaH作为护理的参与度 模型为了实现这一目标，我们将：1）描述患者，护理人员和提供者对风险的感知 HaH的权衡、需求和护理偏好; 2）与患者、护理人员和提供者合作， 设计医院级门诊管理评估和决策支持（HOME-DS），一个健康IT- 整合风险模型概率以及患者和护理人员偏好的启用的SDM解决方案;以及3） 评估在急性护理中实施HOME-DS的可行性，并确定HaH的接受率。我们 HOME-DS将重点关注因疑似肺炎住院的18岁及以上成年人，这是一种流行病 这是HaH模型中通常包含的条件。我们将应用先前验证的和广泛的 接受肺炎严重程度指数（PSI）作为HOME-DS的定量风险评分输入。用户角色 最初的HOME-DS原型的需求将通过与患者的关键线人访谈来确定 肺炎住院患者，他们的护理人员和提供者（目标1）;以用户为中心的设计原则将进一步 指导HOME-DS原型（目标2）的迭代开发;我们将测试实施的可行性 HOME-DS在急性护理中指导患者和护理人员在选择医院级护理时做出决策， 家庭或传统医院（目标3）。我们假设HOME-DS在供应商内部实现是可行的 住院流程，并可以产生50%的参与率在医院。拟议项目将 接触患有肺炎的异质性人群，因为这是一个需要大量急性护理的人群 使用成本，以及在理解执行挑战方面存在巨大差距，无法解释为什么 传统的住院治疗没有得到更广泛的应用。结果将证明健康IT的价值， 将临床数据与患者偏好相结合，以促进有效的SDM， 护理选项。

PROJECT SUMMARY Inpatient hospitalization is costly – accounting for $1.1 trillion in health care spending annually in the United States – and is associated with high morbidity and mortality risks. Hospital at Home (HaH) is an alternative care model where care teams provide acute hospital-level care in a patient’s home. Despite decades of data that support HaH efficacy relevant to key patient-centered outcomes, barriers to HaH participation limit its widespread adoption and population health impact. Our central hypothesis is that providers and patients require Clinical Decision Support (CDS) integrating data from disparate sources and a Shared Decision Making (SDM) framework to help inform point-of-care decisions regarding HaH and surmount low participation rates. The overarching goal of our work is to improve value-driven care by helping patients engage in the decision of which acute-level care option best meets their needs. The objective of this study is to evaluate whether a Health Information Technology (IT)-enabled SDM solution incorporating expected patient outcomes and preferences and deployed at the point-of-care improves patient and provider participation in HaH as a care model. To achieve this objective, we will: 1) characterize patient, caregiver, and provider perceptions of the risk tradeoffs, needs, and care preferences for HaH; 2) partner with patients, caregivers, and providers to iteratively design Hospital-level Outpatient Management Evaluation and Decision Support (HOME-DS), a Health IT- enabled SDM solution that incorporates risk-model probabilities and patient and caregiver preferences; and 3) evaluate the feasibility of implementing HOME-DS in acute care and establish the acceptance rate of HaH. We will focus HOME-DS on adults aged 18 and older hospitalized with suspected pneumonia, a prevelant condition that has been commonly included in HaH models. We will apply the previously validated and broadly accepted Pneumonia Severity Index (PSI) as the quantitative risk score input for HOME-DS. User personas and needs for the initial HOME-DS prototype will be defined through key informant interviews with patients hospitalized with pneumonia, their caregivers, and providers (Aim1); user-centric design principles will further guide iterative development of the HOME-DS prototype (Aim 2); and we will test the feasibility of implementing HOME-DS in acute care to guide patient and caregiver decision making in selecting hospital level care in the home or traditional hospital (Aim 3). We hypothesize HOME-DS is feasible to implement within the provider workflow for hospital admission and can yield participation rates in HaH of 50%. The proposed project will engage a heterogeneous population with pneumonia, as this is a population with substantial acute care utilization costs and a large gap in understanding implementation challenges to explain why alternatives to traditional hospitalization are not used more widely. Results will demonstrate the value of Health IT that integrates clinical data with patient preferences to promote effective SDM enhancing patient-centered acute care options.