Guidelines Applied in Practice-GAP: Heart Failure Care

该项目的总体目的是为实施住院心脏护理循证指南开发一种结构化的方法，该项目的总体目的是为支持规划和可行性研究提供资金。文献表明，使用这样的指南可以减少急诊环境中的住院时间，并将护理转移到门诊场所，同时相应地降低成本。然而，文献也支持了 实施新的护理模式。这个项目将有四个主要目标：(1)通过伙伴关系开发一个全面心力衰竭(HF)护理的循证模式，该模式可供每个生防护中心区域轻易采用并纳入现有活动；(2)调整ACC的指南实用(GAP)项目的干预措施，以改善对心力衰竭的护理；(3)实施信息技术应用，包括支持第一和第二目标的计算机化医生订单录入系统，特别是在管理慢性疾病状态如心力衰竭的背景下，以及(4)展示在各种不同的保健组织、提供者团体、专业医学协会和保健信息技术公司及其利益攸关方之间建立和保持有效、广泛的伙伴关系的能力。在规划阶段将审查执行准则的两个方面。首先，研究小组将检查知识共享 他还提出了一个框架，并提出了一个具体框架，作为教育和实施方法的范本。例如，需要审查的模型包括采用变革的跨理论框架和狄克逊关于知识转移的结构和过程的“共同知识”框架。将审查的准则采纳的第二个方面包括技术在促进变革和支持方面的作用 练习一下。多学科项目委员会，包括一家健康信息技术公司(McKesson)的代表，将审查将选定的指南编程到现有和新的计算机化医嘱录入和其他IT工具中的可行性和成本效益。该项目第一阶段的目标包括：为天主教健康伙伴系统修改具体的心力衰竭指南和相关措施，该系统由5个州的31家医院组成(2001年日历年出院了8,000多名心力衰竭患者)；制定了一个知识传授框架，用来组织指南的实施；以及为CPOE开发一个原型。至少有两个医院地点将作为试点，参与制定执行办法，并测试执行协议和CPOE的使用。根据规划阶段的结果，将在第二阶段增加场地，在此期间，我们将根据第一阶段的结果对软件和协议进行修订，并实施经修订的信息技术辅助方法。

The overall purpose of this project, for which funding to support the planning and feasibility study is requested by this application, is to develop a structured approach for the implementation of evidence-based guidelines for inpatient cardiac care. Literature indicates that the use of such guidelines can decrease length of stay in the acute setting and shift care to outpatient venues, with commensurate decrease in cost. However, literature also supports the difficulty of implementing new models of care. This project will have 4 major aims: (1) To develop through the partnership an evidence-based model for comprehensive Heart Failure (HF) care that can be readily adopted by each CHP region and incorporated into existing activities; (2) To adapt the interventions of the ACC's Guidelines Applied in Practice ("GAP") project for improving AMI care to HF care; (3) To implement information technology applications, including computerized physician order entry ("CPOE") systems that support the first and second aims, especially in the context of managing a chronic disease state such as HF, and (4) To demonstrate the ability to establish and sustain effective, broad-based partnerships among a variety of diverse health care organizations, provider groups, professional medical societies and health care information technology corporations and their stakeholders. Two aspects of implementing guidelines will be examined during the planning phase. First, the study team will examine knowledge sharing frameworks and propose a specific framework to serve as the model for the educational and implementation approach. Among the models to be examined are, for example, trans-theoretical frameworks for the adoption of change and Dixon's "common knowledge" framework concerning the structure and process of knowledge transfer. The second aspect of guideline adoption to be examined includes the role of technology in facilitating change and supporting practice. The multidisciplinary project council, including representatives from an health information technology company (McKesson), will examine the feasibility and cost-effectiveness of programming the selected guidelines into existing and new computerized physician order entry and other IT tools. Objectives for phase I of the project include: adaptation of specific HF guidelines and associated measures for the Catholic Health Partners system, consisting of 31 hospitals located in 5 states (which discharged over 8,000 patients with HF during calendar year 2001); development of a knowledge transfer framework with which to structure implementation of the guidelines; and the development of a prototype for the CPOE. At least two hospital sites will serve as the pilot sites, participating in the development of the implementation approach, and testing the implementation protocols and the use of the CPOE. Based on the findings of the planning phase, additional sites will be added in phase II, during which we will make revisions to the software and protocols based on phase I results, and implement the revised information technology-assisted approach.