Medication Intervention in Transitional Care to Optimize CKD Outcomes & Costs

过渡期护理中的药物干预可优化 CKD 结局

• 批准号: 8232548
• 负责人: Cindy Lou Corbett
• 金额: $ 31.34万
• 依托单位: SACRED HEART MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-30 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8232548
• 关键词: 21 year old; Accident and Emergency department; Acute; Adoption; Adult; Adverse event; Age; Agreement; Blinded; Blood Pressure; Caring; Cessation of life; Charge; Chronic; Chronic Disease; Chronic Kidney Failure; Clinical; Clinical Research; Clinical Trials Design; Clinical assessments; Cognitive; Comorbidity; Complex; Computational algorithm; Continuity of Patient Care; Cost Savings; Data; Diabetes Mellitus; Diagnosis; Dialysis procedure; Disease Management; Disease Outcome; Disease Progression; Economics; Effectiveness; Enzyme Inhibition; Family member; Focus Groups; General Population; Goals; Health; Health Care Costs; Health Professional; Healthcare Systems; Home environment; Hospitalization; Hospitals; Informed Consent; Institutional Review Boards; Intervention; Kidney Transplantation; Knowledge; Lead; Learning; Length of Stay; Logistic Regressions; Measures; Medication Management; Methods; Metric; Mission; Modeling; Myocardial Infarction; National Institute of Diabetes and Digestive and Kidney Diseases; Outcome; Outcome Measure; Outpatients; Participant; Patient Care; Patient Transfer; Patients; Peptidyl-Dipeptidase A; Pharmaceutical Preparations; Pharmacists; Pilot Projects; Population; Public Health; Qualitative Research; Randomized; Recommendation; Regimen; Regression Analysis; Research; Research Design; Research Personnel; Resolution; Risk; Risk Factors; Sampling; Self Management; Staging; Surveys; Survivors; System; Testing; Translating; Type 2 Angiotensin II Receptor; Visit; Work; Writing; base; blind; blood pressure regulation; clinically relevant; cost; disorder risk; evidence base; glycemic control; health literacy; high risk; hospital readmission; hypertension control; improved; innovation; medication compliance; novel strategies; prevent; primary outcome; sex

DESCRIPTION (provided by applicant): Project summary Transitional care interventions reduce hospital readmissions and slow the progression of declining health in the general population of hospitalized patients. What is not known is the impact transitional care interventions can have for the hospitalized CKD population. CKD patients are in critical need of improved transitional care that includes accurate and comprehensive medication information transfer. The main objective of this application is to pilot-test the effectiveness of a medication information transfer intervention to improve clinically-relevant outcomes in CKD. To this end, the following Specific Aims will be achieved: 1. Evaluate the impact of transitional care interventions on acute care utilization following hospital discharge among patients with CKD. 2. Evaluate the impact of transitional care strategies on management of CKD risk factors and complications. Focus groups will first be conducted to assure relevance and to refine the intervention. A qualitative research design with convenience sampling will be used to survey recently hospitalized CKD patients (n~10) and their healthcare professionals (n~10). The medication information transfer intervention will be evaluated in a pilot study using a randomized, single-blind clinical trial design. Participants and the pharmacist interventionist will have knowledge of group assignment, but the other investigators and research staff will be blinded. Study entry criteria will include hospitalized patients >21 years old (n=120) who have a diagnosis of CKD stages 3-5 (not including those treated by dialysis or kidney transplant). After obtaining IRB-approved written informed consent, patients will be randomized by computer algorithm for group assignment, stratifying according to diabetes status. The pharmacist will visit participants in the home within 5 days of hospital discharge. The 5As (Assessment, Advice, Agreement, Assistance, and Arrangements) Self-Management Model will be used to implement the medication information transfer intervention. Clinical assessments will be performed at baseline and at 30 and 90 days. Primary outcome measures for Specific Aim 1 will be acute care utilization (emergency department visits and hospitalizations). The main outcomes for Specific Aim 2 will be measures of CKD risk factors and complications. Blood pressure will be the primary outcome for this aim because hypertension control is the most consistent recommendation for slowing CKD progression. Logistic regression analyses will be employed controlling for age, sex, CKD stage, co- morbidities, Charleson score, cognitive status, medication adherence and health literacy. Cost will be analyzed based on charges from hospitalization through the following 90 days using a difference-of- difference approach. This contribution is significant because it will define methods to overcome system barriers that result in impaired quality and continuity of care. The proposed research is innovative because it integrates established clinical strategies with systems approaches to improve patient care, thereby testing a fundamentally new approach to advance CKD management. PUBLIC HEALTH RELEVANCE: Project narrative the proposed research is relevant to public health because it will positively impact a common, deadly, and costly chronic disease - CKD - by reducing acute care utilization and costs as well as by improving outpatient management. This medication information transfer intervention in the transitional care of hospitalized CKD patients will have wide-appeal for adoption by healthcare systems and for other chronic illnesses. The project supports the mission of NIDDK by translating lessons learned from clinical research in CKD into improved clinical outcomes that can be readily measured and anticipated in practice.

描述（由申请人提供）：项目摘要过渡性护理干预措施减少了住院患者的一般人群的再入院率，并减缓了健康状况下降的进展。目前尚不清楚的是过渡性护理干预对住院CKD人群的影响。CKD患者迫切需要改善过渡期护理，包括准确和全面的药物信息传递。该应用程序的主要目标是对药物的有效性进行试点测试 信息传递干预，以改善CKD的临床相关结局。为此，将实现以下具体目标：1。评估过渡性护理干预措施的影响 CKD患者出院后的急性护理利用率。2.评估过渡期护理策略对CKD风险因素和并发症管理的影响。将首先组织焦点小组，以确保相关性并完善干预措施。将采用方便抽样的定性研究设计，调查近期住院的CKD患者（n~10）及其医疗保健专业人员（n~10）。将采用随机、单盲临床试验设计，在初步研究中评价药物信息传递干预。参与者和药剂师干预人员将了解 组分配，但其他研究者和研究人员将设盲。研究进入标准将包括诊断为CKD 3-5期的>21岁的住院患者（n=120）（不包括通过透析或肾移植治疗的患者）。在获得IRB批准的书面知情同意书后，患者将通过计算机算法进行随机分组，并根据糖尿病状态进行分层。药剂师将在 出院后5天内回家。5A（评估、建议、同意、协助和安排）自我管理模式将用于实施药物信息传递干预。将在基线以及第30天和第90天进行临床评估。具体目标1的主要结局指标将是急性护理利用率（急诊科就诊和住院）。具体目标2的主要结局将是CKD风险因素和并发症的指标。血压将是这一目标的主要结局，因为控制高血压是减缓CKD进展的最一致建议。将采用逻辑回归分析，控制年龄、性别、CKD分期、合并症、Charleson评分、认知状态、药物依从性和健康素养。将使用差异差异法，根据从住院到随后90天的费用分析成本。这一贡献意义重大，因为它将确定克服导致护理质量和连续性受损的系统障碍的方法。拟议的研究是创新的，因为它将既定的临床策略与系统方法相结合，以改善患者护理，从而测试一种全新的方法来推进CKD管理。 公共卫生关系：项目叙述拟议的研究与公共卫生相关，因为它将通过减少急性护理利用和成本以及改善门诊管理，对常见的，致命的和昂贵的慢性疾病- CKD产生积极影响。在住院CKD患者的过渡性护理中，这种药物信息传递干预将对医疗保健系统和其他慢性疾病的采用具有广泛的吸引力。该项目支持NIDDK的使命，将从CKD临床研究中吸取的经验教训转化为可以在实践中容易测量和预期的改善的临床结果。