Medication Intervention in Transitional Care to Optimize CKD Outcomes & Costs

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的是对药物的有效性进行初步测试 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。

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.