PHYSICIAN-NURSE MANAGEMENT OF ELDERS WITH HEART FAILURE

心力衰竭老年人的医师护士管理

• 批准号: 6315439
• 负责人: J. SANFORD SCHWARTZ
• 金额: $ 38.22万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-09-30 至 2003-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6315439
• 关键词: behavioral /social science research tag; clinical research; data collection methodology /evaluation; functional ability; health care personnel performance; health care quality; heart failure; hospital utilization; human morbidity; human mortality; human old age (65+); human subject; nurse performance; outcomes research; patient care management; physicians; prognosis; quality of life; therapy compliance

More than a million older Americans with heart failure experience high mortality, disabling symptoms, loss of independence, depression and repeated hospitalizations. Care of these patients is complex, challenging and often inadequate. New models of physician-advanced practice nurse (APN) co-management of elders during an acute episode of heart failure and extending from hospital to home have demonstrated promise in improving patient outcomes and reducing costs of care. However, the mechanisms that contribute to effectiveness of these new models of care are not well understood. Nor is it clear how care delivered by physician-APN teams differs from traditional care models. The major objective of this study is to examine differences in processes and outcomes of alternative models of physician-nurse co-management among older adults with acute heart failure. This study will compare four physician-nurse models for co-managing elders during an exacerbation of heart failure: a) in the use of evidence-based practice (care process); b) on the primary outcomes of quality life and rehospitalization; and c) for relationships among the use of evidence-based practice, the primary outcomes (quality life and rehospitalization) and intermediary variables (patient adherence with prescribed diet, medications and activity; adverse clinical events; access to health services; functional status; depression; subjective health rating and patient satisfaction). The study also will identify patient, caregiver, environmental, provider and health system factors that facilitate or interfere with or impede physician-nurse co-management. Clinical, sociodemographic and economic data collected during an on-going NINR-funded multi-center RCT will be supplemented by collection and analysis of an enriched set of process and outcomes data on study subjects (N=250). This knowledge is required to inform the design of patient care management models for the growing population of high-risk complex, elderly patients. Study findings will guide future efforts to measure adherence by provider teams to evidence-based practice and to link providers' adherence with patient outcomes. Findings from the exploratory analyses will advance understanding of the range and complexity of factors that influence outcomes and help explain the observed heterogeneity in patient outcomes following APN interventions. This study thus will facilitate development in an increasingly cost-constrained environment of high quality, targeted effective and efficient interventions to improve health for high-risk elderly patients with complex health needs.

100多万有心力衰竭经历的美国老年人 高死亡率，致残症状，丧失独立性，抑郁和 反复住院治疗。这些患者的护理是复杂的、具有挑战性的和 通常是不充分的。新型内科高级执业护士(APN) 老年人在心力衰竭和延迟性心力衰竭急性发作期间的共同管理 从医院到家庭都展示了改善患者结局的前景 以及降低护理成本。然而，有助于实现这些目标的机制 这些新的护理模式的有效性还没有被很好地理解。也不是 明确由医生-APN团队提供的护理与传统护理有何不同 模特们。这项研究的主要目的是检查在 可供选择的医护共同管理模式的过程和结果 在患有急性心力衰竭的老年人中。这项研究将比较四个 在心脏恶化期间共同管理老年人的医生-护士模式 失败：a)使用循证做法(护理程序)；b)在 高质量生活和再住院的主要结果；以及c) 循证实践的使用与主要结果之间的关系 (生活质量和再住院)和中介变量(患者 坚持规定的饮食、药物和活动；对临床不利 事件；获得卫生服务；功能状态；抑郁；主观 健康评级和患者满意度)。这项研究还将确定患者， 护理者、环境、提供者和卫生系统因素 干扰或阻碍医生和护士的共同管理。临床上， 在NINR资助的持续调查期间收集的社会人口和经济数据 多中心随机对照研究将通过收集和分析丰富的 研究对象的过程和结果数据集(N=250)。这一知识是 需要为不断增长的患者护理管理模式的设计提供信息 高危人群复杂，老年患者多。研究结果将指导 衡量提供者团队对循证证据遵守程度的未来努力 并将提供者的依从性与患者的结果联系起来。调查结果来自 探索性的分析将促进对范围和复杂性的理解 影响结果并有助于解释观察到的异质性的因素 APN干预后的患者预后。因此，这项研究将 在成本日益受限的高成本环境中促进开发 高质量、有针对性的有效和高效的干预措施，以改善 具有复杂健康需求的高危老年患者。