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A Technology-Assisted Care Transition Intervention for Veterans with Chronic Heart Failure or Chronic Obstructive Pulmonary Disease

针对患有慢性心力衰竭或慢性阻塞性肺疾病的退伍军人的技术辅助护理过渡干预

基本信息

批准号：
10512740
负责人：
Timothy Patrick Hogan
金额：
--
依托单位：
EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-06-01 至 2021-06-30
项目状态：
已结题

项目摘要

DESCRIPTION (provided by applicant): The last decade has seen a steady increase in the resources that VHA uses to treat chronic heart failure (CHF) and Chronic Obstructive Pulmonary Disease (COPD), both of which are among the most common reasons for admission and re-admission in VHA facilities. Multi-component care transition interventions can be effective, but are costly. One approach to reduce complexity and costs is to offload some work to technology. Informed by the sociotechnical model, this study proposes a technology-assisted care transition intervention founded on the concept of a virtual nurse that interacts with Veterans through different technology channels. The virtual nurse is an anthropomorphized computer program designed to simulate a discharge nurse. During the inpatient stay, the virtual nurse will appear on a computer touch screen and will educate Veterans with CHF or COPD about the important components of a care transition (drawing on the Coleman Care Transition Model) as well as how to send and receive text messages on their mobile phone. Following discharge to home, the virtual nurse will continue to coach Veterans and their family members and improve post-discharge access to care through two-way computer-tailored text messaging made possible by VHA's new HealtheDialog system. Our specific aims are to: 1. Refine methods and collect formative measures to guide implementation 2. Conduct an implementation trial of the technology-assisted care transition intervention 3. Evaluate the intervention, including its effectiveness, implementation, and budget impact. We propose a mixed methods formative assessment and simulation experiment to refine existing technologies to the VA care transition setting (Aim 1). This will be followed by a multi-site hybrid type 2 implementation trial (Aims 2 and 3) conducted at three purposefully-selected VHA facilities. The trial will evaluate the effectiveness of the virtual nurse intervention, and also evaluate a phased implementation protocol moving from centralized support (through a dedicated discharge assistant funded by the study) to facilitated distribution of the intervention (through nurse or nurse assistant members of clinical teams) into twelve clinical teams.

描述（由申请人提供）：在过去的十年中，VHA用于治疗慢性心力衰竭（CHF）和慢性阻塞性肺疾病（COPD）的资源稳步增加，这两种疾病都是VHA设施入院和再次入院的最常见原因。多组分护理过渡干预措施可能是有效的，但成本高昂。降低复杂性和成本的一种方法是将一些工作卸载到技术上。通过社会技术模型的通知，本研究提出了一种技术辅助护理过渡干预的虚拟护士，通过不同的技术渠道与退伍军人互动的概念。虚拟护士是一个拟人化的计算机程序，旨在模拟出院护士。在住院期间，虚拟护士将出现在计算机触摸屏上，并将教育CHF或COPD退伍军人有关护理过渡的重要组成部分（借鉴科尔曼护理过渡模型）以及如何在他们的移动的手机上发送和接收短信。出院回家后，虚拟护士将继续指导退伍军人及其家人，并通过VHA新的HealthDialog系统提供的双向计算机定制短信服务，改善出院后获得护理的机会。我们的具体目标是：1.完善方法，收集形成性措施，以指导实施2.开展技术辅助护理过渡干预的实施试验3.评估干预措施，包括其有效性、实施情况和预算影响。我们提出了一个混合的方法形成性评估和模拟实验，以完善现有的技术，VA护理过渡设置（目标1）。随后将在三个专门选择的VHA设施进行多地点混合2型实施试验（目标2和3）。该试验将评估虚拟护士干预的有效性，并评估从集中支持（通过研究资助的专门出院助理）到促进干预（通过临床团队的护士或护士助理成员）分配到12个临床团队的分阶段实施方案。