Implementation and Sustainment of Team-Based Practice Transformation to Improve Heart Failure Care and Outcomes

实施和维持基于团队的实践转型，以改善心力衰竭护理和结果

• 批准号: 10451730
• 负责人: Erin Lindsey Blakeney
• 金额: $ 16.69万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10451730
• 关键词: Active Learning; Address; Adherence; Adopted; Adult; Adverse event; Affect; American; Caring; Characteristics; Childhood; Clinical Pathways; Clinical Research; Collaborations; Communication; Complex; Data; Development; Electronic Health Record; Evaluation; Event; Family; Family member; Foundations; Funding; Future; Goals; Grant; Health; Health Policy; Health Professional; Heart Transplantation; Heart failure; Heart-Assist Devices; Hospitals; Implant; Inpatients; Intervention Studies; Interview; Knowledge; Lead; Length of Stay; Linear Models; Link; Medical; Medical center; Mentors; Mentorship; Methods; Modeling; National Heart, Lung, and Blood Institute; Observational Study; Outcome; Outcomes Research; Palliative Care; Pathway interactions; Patient Care; Patient-Centered Care; Patient-Focused Outcomes; Patients; Play; Policy Maker; Population; Positioning Attribute; Postdoctoral Fellow; Prospective cohort study; Quality of Care; Questionnaires; Regression Analysis; Reporting; Research; Research Design; Research Methodology; Research Personnel; Resolution; Role; Safety; Sampling; Site; Structure; Survival Rate; System; Testing; Time; Training; Universities; Variant; Washington; Work; base; care outcomes; cost; design; disparity reduction; evidence base; experience; hospital readmission; implementation evaluation; implementation outcomes; implementation science; improved; innovation; member; negative affect; novel; patient engagement; patient oriented; readmission rates; safety outcomes; satisfaction; standard of care; success

PROJECT SUMMARY Heart failure (HF) is a costly and complex health condition affecting millions of Americans. HF care is often fragmented which negatively affects quality, safety, and patient-centered outcomes. Structured Interprofessional Bedside Rounds (SIBR) is a model of care developed to bring interprofessional team members together with patients and families using a structured format to collaboratively arrive at a daily care plan. The SIBR model is characterized by four core components: an interprofessional approach, utilization of a rounding structure, intentional patient and family engagement, and development of a shared daily care plan. A growing body of evidence associates SIBR implementation with improvements in team and patient outcomes. The hypothesized mechanism through which SIBR operates is that having a predictable structure leads to improvements in communication, fewer gaps in care, and more consistent utilization of evidence-based approaches. These changes are thought to lead to improvements in patient outcomes such as, length of stay, readmission rates, patient-centeredness of care, and safety/adverse events. Despite frequent improvements in outcomes following SIBR implementation, an evidence gap exists as to the role that fidelity (adherence) to the SIBR model plays in how and why this model works and the extent to which outcomes can be further improved if fidelity is higher. To address this knowledge gap, this proposal leverages a timely opportunity to study SIBR fidelity and its relationship to care and outcomes among patients with advanced HF at the University of Washington Medical Center, where a SIBR model has been the standard of care for 4+ years. The central hypothesis is that higher- fidelity SIBR will be associated with better outcomes. To test this hypothesis, I will carry out a prospective cohort study to achieve three specific aims: (1) identify associations between SIBR fidelity and patient outcomes, (2) determine the extent to which SIBR fidelity predicts time to initiation and completion of an evidence-based “Advanced HF Work-Up Pathway”, and (3) examine patient and family experiences of care quality and safety in the context of higher- and lower- fidelity SIBR. These aims will lay the groundwork for an initial multi-site R01 to study SIBR in practice and a future R-level grant to implement and evaluate an optimized SIBR model. Through this work, I will obtain formal training in HF outcomes research, advanced implementation science study designs, and patient-oriented clinical research methods. I will be mentored by an expert team of NHLBI-funded researchers, Bryan Weiner (primary mentor, implementation science), Randall Curtis (communication and palliative care), Brenda Zierler (interprofessional collaboration and clinical pathways), and Kevin O'Brien (advanced heart failure care). The combination of mentorship, coursework, and experiential learning will position me to become an independent investigator using scientifically rigorous approaches to evaluate the implementation and outcomes of evidence-informed patient- and family-centered models of care.

项目概要 心力衰竭 (HF) 是一种昂贵且复杂的健康状况，影响着数百万美国人。心衰护理通常是 分散，这会对质量、安全和以患者为中心的结果产生负面影响。结构化跨专业 床边查房 (SIBR) 是一种护理模式，旨在将跨专业团队成员聚集在一起 患者和家属使用结构化格式协作制定日常护理计划。 SIBR 模型为 其特点是四个核心组成部分：跨专业方法、舍入结构的利用、 患者和家人的有意参与，以及制定共同的日常护理计划。不断成长的身体 有证据表明 SIBR 的实施与团队和患者治疗结果的改善相关。假设的 SIBR 运作的机制是，拥有可预测的结构会带来改进 沟通、减少护理差距以及更一致地利用循证方法。这些 人们认为这些变化会改善患者的治疗效果，例如住院时间、再入院率、 以患者为中心的护理以及安全/不良事件。尽管以下结果经常得到改善 SIBR 实施中，对于 SIBR 模型的保真度（遵守）所发挥的作用，存在证据差距 该模型如何以及为何发挥作用，以及如果保真度更高，结果可以进一步改善的程度。到 为了解决这一知识差距，该提案利用了一个及时的机会来研究 SIBR 保真度及其 华盛顿大学医学院晚期心力衰竭患者的护理和结果的关系 中心，SIBR 模型已成为护理标准 4 年多了。中心假设是更高的 保真 SIBR 将带来更好的结果。为了检验这个假设，我将进行一个前瞻性队列研究 研究旨在实现三个具体目标：(1) 确定 SIBR 保真度与患者结果之间的关联，(2) 确定 SIBR 保真度预测基于证据的启动和完成时间的程度 “高级心力衰竭检查途径”，以及 (3) 检查患者和家属在护理质量和安全方面的经验 较高和较低保真度 SIBR 的背景。这些目标将为最初的多站点 R01 奠定基础 研究实践中的 SIBR 以及未来的 R 级资助，以实施和评估优化的 SIBR 模型。通过 这项工作，我将获得高频成果研究、高级实施科学研究设计方面的正式培训， 以及以患者为中心的临床研究方法。我将接受 NHLBI 资助的专家团队的指导 研究人员：Bryan Weiner（主要导师，实施科学）、Randall Curtis（沟通和 姑息治疗）、Brenda Zierler（跨专业合作和临床路径）和 Kevin O'Brien （高级心力衰竭护理）。指导、课程作业和体验式学习的结合将定位 我成为一名独立调查员，使用科学严谨的方法来评估 以患者和家庭为中心的循证护理模式的实施和结果。