Guidelines Applied in Practice-GAP: Heart Failure Care

实践应用指南-GAP：心力衰竭护理

• 批准号: 6618445
• 负责人: DONALD E CASEY
• 金额: $ 8.12万
• 依托单位: CATHOLIC HEALTHCARE PARTNERS
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-30 至 2003-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6618445
• 关键词: clinical research; computer assisted patient care; cooperative study; critical care; health service demonstration project; heart failure; hospital patient care; human subject; interdisciplinary collaboration; patient care management; patient care planning; patient oriented research; therapy compliance

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.

该项目的总体目的是开发一种结构化方法，用于实施住院心脏病护理循证指南，本申请要求为该项目的规划和可行性研究提供资金。文献表明，使用此类指南可以缩短急性环境中的住院时间，并将护理转移到门诊场所，从而相应降低成本。然而，文学也支持的困难， 实施新的护理模式。该项目将有4个主要目标：（1）通过合作伙伴关系开发一个基于证据的全面心力衰竭（HF）护理模式，该模式可以被每个CHP地区随时采用并纳入现有活动;（2）调整ACC的实践应用指南（GAP）项目的干预措施，以改善AMI护理到HF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嘱输入（“CPOE”）系统，特别是在管理慢性疾病状态如HF的背景下，以及（4）展示建立和维持有效的能力，在各种不同的卫生保健组织、提供者团体、专业医疗协会和卫生保健信息技术公司及其利益攸关方之间建立基础广泛的伙伴关系。在规划阶段将审查执行准则的两个方面。首先，研究小组将研究知识共享 在这方面，我们将制定一个框架，并提出一个具体的框架，作为教育和实施方法的模式。例如，要审查的模式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。要审查的准则采用的第二个方面包括技术在促进变革和支持 实践多学科项目理事会，包括一家保健信息技术公司（McKesson）的代表，将审查将选定的准则编入现有和新的计算机化医嘱输入和其他信息技术工具的可行性和成本效益。该项目第一阶段的目标包括：为天主教保健伙伴系统调整具体的心力衰竭指导方针和相关措施，该系统由位于5个州的31家医院组成（2001日历年期间，该系统收治了8 000多名心力衰竭患者）;制定一个知识转让框架，以便组织指导方针的实施;以及为《预防和控制心力衰竭方案》制定一个原型。至少有两个医院站点将作为试点站点，参与实施方法的制定，并测试实施协议和CPOE的使用。根据规划阶段的研究结果，我们会在第二阶段增加更多地点。在第二阶段，我们会根据第一阶段的研究结果，修订软件和规程，并实施经修订的信息技术辅助方法。