Testing the Re-Engineered Hospital Discharge

测试重新设计的医院出院

• 批准号: 7010468
• 负责人: BRIAN William JACK
• 金额: $ 29.11万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-07-01 至 2007-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7010468
• 关键词: behavioral /social science research tag; clinical research; clinical trials; community health services; computer program /software; cooperative study; data collection methodology /evaluation; emergency care; health care service evaluation; health education; health service demonstration project; health services research tag; home health care; hospital analysis; hospital utilization; human subject; medically underserved population; outcomes research; outpatient care; patient care management; patient care planning; patient safety /medical error; posthospitalization care; questionnaires

DESCRIPTION (provided by the applicant): Background: This project responds to the problems of non-standardized care and discontinuity at hospital discharge. Post-discharge adverse events are common and have been well documented. However, to date, there are no studies demonstrating the effectiveness of any procedures or tools designed to reduce them. This work builds on our "Safe Practices Implementation Challenge Grant" in which we developed the "Reengineered Hospital Discharge" tool, a set of 10 discrete, mutually reinforcing components. Hypotheses: The newly designed "Re-engineered Hospital Discharge" intervention will (1) reduce the percentage of patients experiencing a post-discharge adverse event, and (2) reduce subsequent hospital utilization (emergency department visits and rehospitalization) within 30 days following hospital discharge. Population Studied: Patients from a network of Community Health Centers discharged from a general medical service at an urban hospital. The subjects studied represent a low-income, ethnically diverse urban population. This study meets AHRQ guidelines for the inclusion of priority populations in research. Methods: 432 adult patients admitted to the general medical service of Boston Medical Center will be enrolled and randomized to (1) those receiving routine discharge as defined by our "Process Map" (Control Group); and (2) those receiving our "Re-engineered Hospital Discharge" intervention, a set of 10 discrete, mutually reinforcing components provided by a case manager and re-enforced by a telephone call 2-4 days after discharge by a clinical pharmacist (Intervention Group). Outcome Measures: The primary patient centered outcomes are: the combined 30-day subsequent hospital utilization (readmission and emergency department use), and health status as measured by the SF-12. Process outcomes include the number and severity of the adverse events related to the discharge 30 days after discharge. Although not a primary outcome, an economic analysis will be completed. Expected Results: This project will provide valuable information about whether the "Re-Engineered Discharge" will reduce adverse events related to discharge and decrease subsequent hospital utilization. Deliverables/Dissemination: An advisory committee of senior Boston Medical Center leaders will oversee the project and, if proven effective, will implement the intervention throughout our Academic Medical Center. The "Re-engineered Hospital Discharge" tool will be widely generalizable and widely disseminated.

描述（由申请人提供）：背景：该项目应对医院出院时的非标准化护理和不连续性的问题。入院后不良事件很常见，并且已经有充分的记录。但是，迄今为止，尚无研究表明旨在减少它们的任何程序或工具的有效性。这项工作建立在我们的“安全实践实施挑战补助金”的基础上，我们开发了“重新设计的医院出院”工具，这是一组10个离散的，相互加强的组件。 假设：新设计的“重新设计的医院出院”干预措施将（1）减少 在出院后30天内，经历了出院后不良事件的患者百分比，以及（2）减少随后的医院利用率（急诊就诊和再住院）。 研究的人口：来自一般性的社区卫生中心网络的患者 城市医院的医疗服务。所研究的受试者代表着低收入，种族多样化的城市人口。这项研究符合AHRQ指南，以将优先人群纳入研究。 方法：432位接受波士顿医疗中心一般医疗服务的成年患者将是 注册并随机分配给（1）那些接受我们的“过程图”定义的常规放电的人（对照组）； （2）那些接受我们“重新设计的医院出院”干预措施的人，这是由案例经理提供的10个离散的，相互加强的组件，并在临床药剂师（干预小组）出院后2-4天通过电话重新加强了电话。 结果指标：以患者为中心的主要结果是：随后30天的总医院利用（再入院和急诊科使用），以及由SF-12衡量的健康状况。过程结果包括与出院后30天相关的不良事件的数量和严重性。尽管不是主要结果，但将完成经济分析。 预期结果：该项目将提供有关是否重新设计的有价值的信息 放电”将减少与出院有关的不良事件，并减少随后的医院利用。 可交付成果/传播：波士顿医疗中心高级领导人的咨询委员会将监督该项目，如果证明有效，将在整个学术医疗中心实施干预措施。 “重新设计的医院出院”工具将被广泛推广并广泛传播。