PHYSICIAN-NURSE MANAGEMENT OF ELDERS WITH HEART FAILURE

超过一百万的美国老年人患有心力衰竭 高死亡率，致残症状，丧失独立性，抑郁症， 反复住院。这些患者的护理是复杂的，具有挑战性的， 往往不足。医生-高级实习护士（APN）新模式 老年人心力衰竭急性发作期间的共同管理 从医院到家庭，已经证明了改善患者预后的前景 降低医疗成本。然而，有助于 这些新的护理模式的有效性还没有得到很好的理解。也不是 明确医生-APN团队提供的护理与传统护理的不同之处 模型本研究的主要目的是研究 医护合作管理替代模式的过程和结果 老年急性心力衰竭患者中。这项研究将比较四个 老年人心脏病急性发作期间的医护合作模式 失败：a）在使用循证实践（护理过程）; B）在 生活质量和再住院的主要结局;以及c） 使用循证实践、主要结果 （生活质量和再住院）和中介变量（患者 遵守规定的饮食、药物和活动;不良临床 事件;卫生服务可及性;功能状态;抑郁;主观 健康等级和患者满意度）。这项研究还将确定患者， 照顾者、环境、提供者和卫生系统因素， 干扰或妨碍医护合作管理。临床， 正在进行的国家核研究所资助的 多中心RCT将通过收集和分析丰富的 研究受试者的过程和结局数据集（N=250）。这种知识是 需要告知病人护理管理模式的设计， 高危复杂人群、老年患者。研究结果将指导 未来努力衡量供应商团队遵守循证 实践，并将提供者的依从性与患者的结果联系起来。的结果 探索性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干预后的患者结局。因此，本研究将 在成本日益受到限制的环境中促进发展， 高质量、有针对性、切实有效的干预措施， 有复杂健康需求的高风险老年患者。

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.