Discharge Information & Support for Patients Receiving Outpatient Care in the ED

出院信息

• 批准号: 8485434
• 负责人: Susan Nicole Hastings
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-06-01 至 2016-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8485434
• 关键词: Accident and Emergency department; Accounting; Address; Admission activity; Ambulatory Care; Area; Back; Care given by nurses; Caring; Case Manager; Chronic; Chronic Disease; Client satisfaction; Clinic; Clinical; Collaborations; Community Services; Disease Management; Emergency Medicine; Family member; Goals; Health; Health Services Accessibility; Health system; Healthcare; Hospitals; Improve Access; Informed Consent; Instruction; Intervention; Lead; Medical; Medical center; Methods; Nurses; Outcome; Outpatients; Patients; Pharmaceutical Preparations; Population; Primary Health Care; Provider; Randomized; Randomized Controlled Trials; Research; Resources; Risk; Role; Sampling; Services; Simulate; Structure; System; Team Nursing; Telephone; Testing; Veterans; Visit; base; cost; design; driving force; evidence base; follow-up; health administration; health care service utilization; high risk; improved; indexing; novel; primary outcome; programs; satisfaction; secondary outcome; treatment as usual

DESCRIPTION (provided by applicant): Background: More than 1 million Veterans receive care in Emergency Departments (EDs) in VA Medical Centers (VAMCs) annually. Nearly 1 in 5 Veterans treated and released from a VAMC ED receive additional unscheduled care in the ED or hospital within 30 days. The risk of repeat ED visits is particularly high among patients with chronic medical conditions who have received ambulatory medical services in the ED previously. An explicit goal of newly developed Patient Aligned Care Teams (PACTs) is to promote continuity in primary care clinics and thereby reduce ED utilization; however, there has been little research to guide PACTs in how to accomplish this. A key role for nurses within PACTs will be telephone management of high risk populations, and Veterans treated and released from the ED represent one such high-risk group. However, no studies have examined both the Veteran and system-level impact of using nurse care managers to support Veterans after an ED visit. Objectives: The overall goal of this study is to examine the impact of a primary care-based nurse telephone support program for Veterans treated and released from the ED who are at high risk for repeat visits. We will test the following hypotheses: H1: Veterans who participate in a primary care-based nurse telephone support program after an ED visit will have a lower rate of ED use in the subsequent 30 days compared to usual care. H2: Veterans who participate in a primary care-based nurse telephone support program after an ED visit will have higher satisfaction compared to usual care. H3: Veterans who participate in a primary care-based nurse telephone support program will have lower total VA costs in the 180 days following an ED visit compared to usual care. Methods: The proposed study is a two group randomized, controlled trial to evaluate a structured nurse telephone support program for Veterans treated and released from the ED who are at high risk for repeat visits. After informed consent is obtained, Veterans will be randomized to nurse telephone support [DISPO ED] or usual care. DISPO ED will consist of 2 calls from a study nurse (simulating the role of a PACT RN Care Manager) within 7 days of the index ED visit, with an option for a 3rd call within 14 days. The primary outcome is a dichotomous outcome defined as any ED use within 30 days or not. Secondary outcomes are patient satisfaction with VA health care at 30 and 180 days, and total VA costs within 180 days. Significance: This study will provide important information about how to promote access to and continuity with PACT for a large population of high risk Veterans. The goal of DISPO ED is not to evaluate a new layer of care; but rather to test an intervention that will contribute to the evidence base for what PACT nurse care managers can and should be doing to promote optimal health and health care utilization among Veterans. Designed in close collaboration with clinical partners, and endorsed by leaders in PACT and emergency medicine, DISPO ED could, if proven effective, be readily implemented using existing PACT resources and staffing.

描述（由申请人提供）： 背景：每年有超过100万退伍军人在VA医疗中心（VAMC）的急诊科（ED）接受护理。近五分之一的退伍军人治疗和释放的VAMC艾德在艾德或医院在30天内接受额外的计划外护理。在患有慢性疾病的患者中，重复艾德就诊的风险特别高，这些患者之前曾在艾德接受过门诊医疗服务。新开发的患者协调护理团队（PACT）的明确目标是促进初级保健诊所的连续性，从而减少艾德的利用;然而，很少有研究指导PACT如何实现这一目标。PACTs中护士的一个关键作用是对高风险人群进行电话管理，而接受治疗并从艾德出院的退伍军人就是这样一个高风险群体。 然而，没有研究已经检查了退伍军人和系统层面的影响，使用护理经理，以支持退伍军人后，艾德访问。 目的：本研究的总体目标是检查一个初级保健为基础的护士电话支持计划的退伍军人治疗和释放的艾德谁是高风险的重复访问的影响。我们将测试以下假设：H1：退伍军人谁参加了初级保健为基础的护士电话支持计划后，艾德访问将有一个较低的比率艾德使用在随后的30天相比，常规护理。H2：退伍军人谁参加了初级保健为基础的护士电话支持计划后，艾德访问将有更高的满意度相比，通常的护理。H3：参加初级护理护士电话支持计划的退伍军人在艾德就诊后180天内的总VA费用低于常规护理。研究方法：拟议的研究是一个两组随机对照试验，以评估结构化的护士电话支持计划的退伍军人治疗和释放的艾德谁是高风险的重复访问。获得知情同意后，退伍军人将随机接受护士电话支持[DISPO艾德]或常规护理。DISPO艾德将包括研究护士（模拟PACT RN护理经理的角色）在首次艾德访视前7天内的2次呼叫，可选择在14天内进行第3次呼叫。主要结局为二分结局，定义为30天内是否使用任何艾德。次要结局是患者在30天和180天时对VA医疗保健的满意度，以及180天内的VA总成本。重要性：这项研究将提供有关如何促进获得和连续性与PACT的高风险退伍军人的大量人口的重要信息。DISPO艾德的目标不是评估一个新的护理层，而是测试一种干预措施，这将有助于PACT护士护理管理人员能够和应该做什么的证据基础，以促进退伍军人的最佳健康和医疗保健利用。DISPO艾德是与临床合作伙伴密切合作设计的，并得到了PACT和急诊医学领导人的认可，如果证明有效，可以利用现有的PACT资源和人员随时实施。