Engaging Patients and Providers in Identifying and Addressing Modifiable Risk Factors to Prevent Community-Acquired Ulcers in Veterans with SCI

让患者和医疗服务提供者参与识别和解决可改变的风险因素，以预防患有 SCI 的退伍军人出现社区获得性溃疡

• 批准号: 10450649
• 负责人: Elizabeth Burkhart
• 金额: --
• 依托单位: EDWARD HINES JR VA HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10450649
• 关键词: Activities of Daily Living; Address; Admission activity; Adoption; Advisory Committees; Affect; Ambulatory Care Facilities; Automobile Driving; Behavior; Caregivers; Caring; Case Study; Clinic; Clinical; Communities; Community based prevention; Data; Denervation; Documentation; Education; Ensure; Equipment; Fostering; Future; Goals; Habits; Health; Health Care Costs; Healthcare Systems; Home; Hospitals; Hour; Incidence; Independent Living; Individual; Inpatients; Institution; Intervention; Interview; Knowledge; Learning; Length of Stay; Life; Life Style; Logic; Methods; Modeling; Morbidity - disease rate; Motor; Numbness; Nursing Homes; Outpatients; Paraplegia; Patients; Perception; Persons; Plant Roots; Prevalence; Prevention; Prevention Guidelines; Prevention education; Prevention strategy; Preventive; Preventive care; Preventive service; Process; Protocols documentation; Provider; Psyche structure; Quadriplegia; Quality of life; Recommendation; Recurrence; Regimen; Reporting; Research Methodology; Resources; Risk; Risk Assessment; Risk Factors; Site; Skin; Skin Care; Spinal cord injury; Standardization; Translating; Ulcer; Veterans; Walking; Work; acute care; chronic care model; cohort; community based participatory research; community center; community setting; complex chronic conditions; compliance behavior; cost; decubitus ulcer; evidence base; experience; feasibility trial; healing; high risk; improved; member; modifiable risk; mortality; patient oriented; pilot test; pressure ulcer prevention; prevent; programs; satisfaction; shared decision making; support tools; tool

The objective of this study is to identify and begin to address the challenges of preventing community- acquired pressure ulcer (CAPrUs) in individuals living with spinal cord injury (SCI) by exploring patient, caregiver, and provider perceived risk factors. We will explore Veteran and caregiver perceptions of CAPrU risk factors using participatory action research [PAR] (photovoice, guided tour) methods and provider perspectives with individual interviews. We will compare SCI providers' perceptions of CAPrU risk factors with those of Veterans and caregivers. We will conduct a Delphi panel with expert panel members to develop, and pilot a risk assessment checklist tool for CAPrUs in an SCI outpatient clinic. Our current health care system is fragmented and well-established HAPrU prevention strategies have not been defined, translated, expanded on or adapted to the outpatient setting, nor have actions and community resources been identified to support ulcer prevention activities in the community. Our study rationale builds on the same logic underlying the U.S. Preventive Services Task Force (USPSTF) recommendations1 and the IOM report, “To Err Is Human” promote developing evidence-based decision support tools to foster meaningful patient-centered productive interactions,2,3 Productive interactions in preventing CAPrUs begin by engaging patient and provider in identifying modifiable risk factors, actions and resources. The proposed checklist is the means for identifying CAPrU risks, actions and resources to stimulate prevention activities in the community. Aims 1 & 2 focus on ensuring the checklist is patient-centered, addresses gaps between the patient and provider perspectives, and is practical and relevant for the community setting. Aim 3 will evaluate whether integrating the checklist into SCI outpatient encounters increases the provision/receipt of CAPrU preventive care and its' impact on new CAPrUs. Our proposed CAPrU checklist is the bridge for patient-provider mutual goal setting in the clinic and for driving prevention activities in the community. We will identify actions and resources needed to operationalize the existing PrU prevention guidelines to community/home settings by: 1) identifying and comparing stakeholder (patient, caregiver, provider) mental models of the challenges in addressing CAPrU risk factors, 2) convening an expert panel of stakeholders (e.g., Veterans, caregivers, providers, and national PrU prevention experts) to develop and validate a risk factor checklist tool that includes specific actions and resources needed to prevent CAPrUs, and 3) evaluating the risk factor checklist tool in an outpatient SCI clinic to determine the feasibility, acceptability, efficacy and integration into work/patient flow in an SCI outpatient clinic. Guided by the USPSTF recommendations and the Wagner Chronic Care Model for improving management of complex chronic conditions, we will create a risk assessment decision support tool to identify risks, actions and resources to promote productive interactions between patients, caregivers and providers. We will use mixed methods to create the tool and conduct a pre-post feasibility trial of that tool in an SCI outpatient clinic. [We will also examine the effect of the tool on new CAPrU incidence at all 3 study sites.] Study products include: 1) an iPad application that automates the risk factor checklist tool and supports provider documentation of risk factors and PrU preventive actions, specific actions and resources needed to prevent CAPrUs for use in the outpatient clinic; 2) a study protocol for implementing the iPad checklist tool during SCI outpatient encounters; and 3) case studies to inform Veterans and SCI providers about risk factors associated with new CAPrUs. This study will create a more consistent approach to CAPrU risk factors and preventive care to be evaluated in a future study.

本研究的目的是确定并开始解决预防社区-的挑战

项目成果

Preventing Community-Acquired Pressure Injuries in Spinal Cord Injury: Online Healthcare Provider Curriculum.

预防脊髓损伤中的社区获得性压力损伤：在线医疗保健提供者课程。

• DOI: 10.1097/rnj.0000000000000437
• 发表时间: 2023
• 期刊: Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses
• 作者: Burkhart,Elizabeth;Zurek,Stacey;Desmond,MaryE;Aguina,Keith;Cabigon,RalphD;Smith,Autumn;Bates-Jensen,Barbara
• 通讯作者: Bates-Jensen,Barbara

Development of a decision support tool to prevent community acquired pressure injuries for use in the spinal cord injury clinic using the delphi technique.

使用德尔菲技术开发决策支持工具，以防止社区获得性压力损伤，用于脊髓损伤诊所。

• DOI: 10.1038/s41393-023-00937-8
• 发表时间: 2023
• 期刊: Spinal cord
• 影响因子: 2.2
• 作者: Burkhart,Lisa;Siddiqui,Sameer;Smith,Autumn;Richardson,Michael;Zachow,Karin;Chua,Walter;Weaver,FrancesM;Skemp,Lisa;Kiefer,Amy;LaVela,SherriL;Bates-Jensen,Barbara
• 通讯作者: Bates-Jensen,Barbara

Provider perspectives of community-acquired pressure injury prevention in veterans with spinal cord injury.

提供者对脊髓损伤退伍军人社区获得性压力损伤预防的看法。

• DOI: 10.1080/10790268.2022.2088505
• 发表时间: 2024
• 期刊: The journal of spinal cord medicine
• 作者: Siddiqui,Sameer;Skemp,Lisa;Burkhart,Lisa
• 通讯作者: Burkhart,Lisa

Triangulation of veteran and provider models of preventing community-acquired pressure injuries in spinal cord injury to reveal convergence and divergence of perspectives.

对预防脊髓损伤中社区获得性压力损伤的退伍军人和提供者模型进行三角测量，以揭示观点的趋同和分歧。

• DOI: 10.1080/10790268.2022.2135714
• 发表时间: 2022
• 期刊: The journal of spinal cord medicine
• 作者: Burkhart,Lisa;Skemp,Lisa;Siddiqui,Sameer
• 通讯作者: Siddiqui,Sameer

Developing a decision support tool to prevent community-acquired pressure injuries in spinal cord injury in ambulatory care: A nurse-led protocol for mix methods research.

开发决策支持工具，以防止门诊护理中脊髓损伤中社区获得性压力损伤：护士主导的混合方法研究方案。

• DOI: 10.1016/j.outlook.2021.01.003
• 发表时间: 2021
• 期刊: Nursing outlook
• 影响因子: 4.3
• 作者: Burkhart,Lisa;Skemp,Lisa;Siddiqui,Sameer;Bates-Jensen,Barbara
• 通讯作者: Bates-Jensen,Barbara