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

 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设施中最常见的入院和再入院原因。多成分护理过渡干预措施可能有效，但代价高昂。降低复杂性和成本的一种方法是将一些工作转移给技术人员。在社会技术模型的启发下，本研究基于虚拟护士的概念，通过不同的技术渠道与退伍军人互动，提出了技术辅助的护理转型干预。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，虚拟护士将出现在电脑触摸屏上，并将教育患有CHF或COPD的退伍军人了解护理过渡的重要组成部分(根据科尔曼护理过渡模型绘制)，以及如何在手机上发送和接收文本消息。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HealtheDialog系统实现的双向计算机定制短信，改善出院后获得护理的机会。我们的具体目标是：1.细化方法和收集形成性措施来指导实施2.进行技术辅助护理转型干预的实施试验3.评估干预措施，包括其有效性、实施情况和预算影响。我们提出了一种混合方法形成性评估和模拟实验来提炼现有技术以适应退伍军人管理局护理过渡环境(目标1)。在此之后，将在三个有目的地选择的VHA设施中进行多地点混合类型2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(通过由研究资助的专用出院助理)到促进将干预(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。

 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.