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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

基本信息

批准号：
8338869
负责人：
Cindy Lou Corbett
金额：
$ 30.79万
依托单位：
SACRED HEART MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-09-30 至 2014-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8338869
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

项目摘要

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.

说明(由申请人提供)：项目摘要过渡期护理干预措施减少住院患者的再入院并减缓一般住院患者健康状况下降的进程。目前尚不清楚过渡性护理干预措施对住院的慢性肾脏病患者的影响。CKD患者迫切需要改进的过渡期护理，包括准确和全面的药物信息传输。此应用程序的主要目标是对药物的有效性进行初步测试信息传递干预以改善慢性肾脏病的临床相关结局。为此，将实现以下具体目标：1.评估过渡期护理干预措施的影响慢性肾脏病患者出院后急诊护理利用分析。2.评估过渡期护理策略对CKD危险因素和并发症管理的影响。将首先进行重点小组，以确保相关性并改进干预措施。采用方便抽样的定性研究设计，对新入院的CKD患者(n~10)及其医护人员(n~10)进行问卷调查。药物信息转移干预将在一项先导性研究中使用随机、单盲临床试验设计进行评估。学员和药剂师干预师将了解小组任务，但其他调查人员和研究人员将被蒙蔽。研究的入选标准将包括21岁的住院患者(n=120)，他们被诊断为CKD 3-5期(不包括那些接受透析或肾移植治疗的患者)。在获得IRB批准的书面知情同意后，患者将通过计算机算法随机分组，根据糖尿病状况进行分层。药剂师将探望参加出院后5天内回家。运用5A(评估、建议、协议、协助、安排)自我管理模式实施用药信息传递干预。临床评估将在基线以及30天和90天进行。具体目标1的主要结果衡量标准是急性护理利用情况(急诊科就诊和住院治疗)。具体目标2的主要结果将是对慢性肾脏病危险因素和并发症的测量。血压将是这一目标的主要结果，因为高血压控制是减缓CKD进展的最一致的建议。Logistic回归分析将用于控制年龄、性别、CKD分期、合并症、Charleson评分、认知状况、服药依从性和健康素养。使用差异法，将根据随后90天的住院费用来分析成本。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体制障碍的方法。这项拟议的研究是创新的，因为它将既定的临床策略与改善患者护理的系统方法相结合，从而测试了一种促进CKD管理的根本新方法。

项目成果

期刊论文数量（3）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Medication Therapy Management after Hospitalization in CKD: A Randomized Clinical Trial.

CKD 住院后的药物治疗管理：随机临床试验。

DOI：
10.2215/cjn.06790617
发表时间：
2018
期刊：
Clinical journal of the American Society of Nephrology : CJASN
影响因子：
0
作者：
Tuttle,KatherineR;Alicic,RadicaZ;Short,RobertA;Neumiller,JoshuaJ;Gates,BrianJ;Daratha,KennB;Barbosa-Leiker,Celestina;McPherson,SterlingM;Chaytor,NaomiS;Dieter,BradP;Setter,StephenM;Corbett,CynthiaF
通讯作者：
Corbett,CynthiaF