I-TRANSFER Improving TRansitions ANd outcomeS oF sEpsis suRvivors

急性护理医院每年出院的败血症幸存者超过150万人。脓毒症幸存者的可能性是普通人的两倍 作为非脓毒症患者在30天内再次住院，其中32%的再次住院发生在7天内 几天。每年，超过三分之一的败血症幸存者在接受治疗后过渡到熟练的家庭保健(HHC)。 住院，护士监测再感染，支持不间断的药物管理和工作 与患者、护理员、其他提供者一起支持持续康复。这项拟议的竞争性更新是 基于我们之前的研究(RO1-NR016014)生成的HHC最佳实践证据，显示了 注册护士的早期就诊和早期门诊提供者的跟进。我们发现30天的再住院 当脓毒症幸存者接受HHC护理时，死亡率降低了7个百分点(相对减少了41%) 出院后2天内就诊，第一周至少再就诊1次，并由门诊医生跟进 与那些没有及时跟进的患者相比，访问时间延长了7天。然而，在全国范围内，只有28%的败血症幸存者 过渡到HHC的世卫组织收到了这一早期访问协议，因为实现该协议有几个障碍 是存在的。为了推进科学，这项拟议的研究将在现实中测试这种做法的有效性 世界，并用务实的1型混合阶梯楔形随机试验研究实施情况 与急性和HHC利益相关者的二元组合作。目标1：测试I- 转移干预与常规护理对30天再住院和急诊科使用情况的比较 在接受家庭医疗护理的败血症幸存者中。阶梯式楔形议定书将涉及一个基准期 没有干预，以及两个步骤，其中随机二元组提供干预。除了通常的 来自两个地点的护理/控制期，来自国家数据的额外幸存者将提供更大的 对照观察样本，加权以产生协变量平衡。这些假说将通过以下方式进行检验 安德森卫生服务行为模型指导下的带有协变量的广义混合模型。在AIM 2我们将：提供关于环境、流程、战略和 I-Transfer实施的决定因素。实施目标以综合治理为指导 实施研究框架。作为同类研究中最大的HHC研究，也是第一个改变这一点的 通过实施科学的护理类型，拟议的研究有可能产生新的知识 关于过渡到家庭健康的过程和在家庭健康中的护理。如果有效，这一干预在此期间的影响 共同的过渡进程可以是广泛的，改善不断增长的弱势人口的结果 败血症幸存者。一个由国家专家组成的咨询小组将协助广泛传播 研究结果。

Acute care hospitals discharge over 1.5 million sepsis survivors annually. Sepsis survivors are twice as likely as non-sepsis patients to be readmitted within 30 days, with 32% of those readmissions occurring within 7 days. Annually, over one third of sepsis survivors transition to skilled home health care (HHC) after their hospitalization where nurses monitor for reinfection, support uninterrupted medication management, and work with patients, caregivers, other providers to support continued recovery. This proposed competing renewal is based on HHC best practice evidence generated by our previous study (RO1-NR016014) showing the value of early visits by registered nurses and early outpatient provider follow-up. We found that 30-day rehospitalization rates were 7 percentage points lower (a 41% relative reduction) when sepsis survivors received a HHC nursing visit within 2 days of hospital discharge, at least 1 more visit the first week, and an outpatient provider follow-up visit by 7 days compared to those without timely follow-up. However, nationwide, only 28% of sepsis survivors who transitioned to HHC received this early visit protocol because several barriers to achieving this protocol exist. To advance the science, the proposed study will test the effectiveness of this practice in the real world and study the implementation with a pragmatic, Type 1 hybrid, stepped wedge randomized trial in partnership with dyads of acute and HHC stakeholders. Aim 1: Test the effectiveness of the I- TRANSFER intervention compared to usual care on 30-day rehospitalization and emergency department use among sepsis survivors receiving home health care. The stepped wedge protocol will involve a baseline period with no intervention, and two steps where randomized dyads provide the intervention. In addition to the usual care/control periods from the dyad sites, additional survivors from national data will provide a much larger sample of control observations, weighted to produce covariate balance. The hypotheses will be tested using generalized mixed models with covariates guided by the Anderson Behavioral Model of Health Services. In aim 2 we will: Produce insights and generalizable knowledge regarding the context, processes, strategies, and determinants of I-TRANSFER implementation. The implementation aim is guided by the Consolidated Framework for Implementation Research. As the largest HHC study of its kind and the first to transform this type of care through implementation science, the proposed study has the potential to produce new knowledge about the process of transition to and care in home health. If effective, the impact of this intervention during this common transition process could be widespread, improving the outcomes for a growing, vulnerable population of sepsis survivors. An Advisory Group of national experts will assist with widespread dissemination of the study results.