REHOSPITALIZATION IN HOME HEALTHCARE PATIENTS WITH COPD

描述(改编自《调查者摘要》)：家庭健康 医疗保健(HHC)是美国医疗保健中增长最快的部分。然而，在 任何患者诊断组的编号和类型(家访、电话 Call)的联系方式差异很大，几乎没有经验证据 以此作为决策依据。与此同时，家庭医疗保健处于 来自付款人的越来越大的压力，要求他们提供证据证明他们的护理是 有效，其中一个衡量有效的标准是 再次住院治疗。虽然重新住院的研究已经在不同的领域进行了 人口，这里几乎没有证据表明是什么导致再次住院 慢性阻塞性肺疾病(COPD)的HHC患者。这个 本研究的目的是为循证医学的发展提供一个模型 需要防止的接触的数量、类型和时间的配置文件 再次住院治疗。这一阶段的工作将针对慢性阻塞性肺疾病患者。 因为他们的健康很脆弱，需要频繁和高昂的费用 家庭健康和医院护理。拟议的研究将检查患者 再次住院前的体征和症状，并比较认知 患者、家属、医生和HHC护士关于 防止后续事件发生所需的接触次数、类型和时间 再次住院治疗。根据这些数据，一个专家小组将确定 被认为最有效的联系的数量、类型和时间 有效地防止再次住院。最后，将会有一个 专家对接触的共识与实际接触的比较 提供给患者。使用三角设计，这项研究将 从30个受访者群体(患者、家属、 医生和HHC护士)在三个州-俄亥俄州、西弗吉尼亚州和 佛罗里达州--使用开放式问题和图表数据。开放式数据 将使用迈尔斯提出的内容分析方法进行分析 和Huberman(1994)。这项研究的长期目标是发展 一种减少慢性病患者再住院的模式 改善HHC服务的使用情况。

DESCRIPTION (As Adapted from the Investigator's Abstract): Home health care (HHC) is the fastest growing segment of U. S. health care. Yet in any patient diagnostic group the number and type (home visit, telephone call) of contacts vary widely, and there is little empirical evidence on which to base decisions. At the same time, home health care is under increasing pressure from payers to provide evidence that their care is effective with one measure of effectiveness being the rate of rehospitalization. While rehospitalization has been studied in various populations, here is little evidence on what leads to rehospitalization of HHC patients with chronic obstructive pulmonary disease (COPD). The aim of this study is to provide a model for developing evidence-based profiles of the number, type, and timing of contacts needed to prevent rehospitalization. This phase of the work will target patients with COPD because of their vulnerable health and need for frequent and high cost home health and hospital care. The proposed study will examine patient signs and symptoms preceding rehospitalization and compare perceptions of patients, family members, physicians, and HHC nurses regarding the number, type, and timing of contacts needed to prevent a subsequent rehospitalization. Based on these data, an expert panel will determine the number, type and timing of contacts perceived most efficient and effective in preventing rehospitalization. Finally, there will be a comparison of the expert consensus on contacts with the actual contacts provided to patients. Using a triangulated design, this study will collect information from 30 respondent groups (patients, family members, physicians, and HHC nurses) in three states-Ohio, West Virginia, and Florida-using open-ended questions and chart data. The open-ended data will be analyzed using the content analysis approach presented by Miles and Huberman (1994). The long-term goal of this research is to develop a model to reduce rehospitalization in chronically ill patients with improved use of HHC services.