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Organizational Determinants of ICU Telemedicine Effectiveness

ICU 远程医疗有效性的组织决定因素

基本信息

批准号：
8753271
负责人：
Jeremy M Kahn
金额：
$ 63.76万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-07-28 至 2018-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8753271
关键词：
Address Adopted American Back Build-it Case Mixes Clinical Complement Complex Critical Care Critical Illness Data Effectiveness Evaluation Excess Mortality Geographic Locations Goals Hospital Administrators Hospitalization Hospitals Improve Access Individual Intensive Care Intensive Care Units Intervention Interview Knowledge Link Measurable Medicare Monitor Outcome Patients Policy Maker Procedures Publishing Qualitative Research Research Research Infrastructure Research Methodology Research Personnel Risk Adjustment Rural Hospitals Sampling Services Site Visit Surveys Techniques Technology Telemedicine Training United States Variant Visit Visual Work base beneficiary care delivery design effectiveness measure effectiveness research experience health care delivery improved innovation mortality novel programs public health relevance rural area socioeconomics success tool trend

项目摘要

DESCRIPTION (provided by applicant): Treatment in an ICU staffed by appropriately trained intensivist clinicians improves survival in critically ill patients. Yet many patients lack access o this level of critical care, particularly in small hospital and rural geographic areas, leading to excess mortality and creating significant socioeconomic disparities. To address this problem many hospitals have adopted ICU telemedicine, a health care delivery innovation which uses audio---visual technology to provide critical care services from a distance. By expanding access to high-quality critical care, ICU telemedicine has great potential to improve survival in critical illness. However, the success of telemedicine is hindered by critical deficiencies in our understanding of how and where this technology is best applied. Telemedicine is a complex intervention, and existing programs vary significantly in both the components of intervention and the clinical setting in which it is used. In turn, studies of telemedicine demonstrate mixed result, with some showing a large mortality benefit and others showing no benefit or even suggesting harm. As a result, decision makers have little guidance regarding how and where to use this potentially transformative technology, if at all. In this project we will address this knowledge ga by identifying the key clinical and organizational factors associated with ICU telemedicine effectiveness. Our central hypothesis is that objective, measurable, clinical and organizational factors will distinguish effective programs from ineffective ones. First, we will use national data on Medicare beneficiaries and an innovative risk--- adjustment procedure to quantify hospital---level variation in the impact of ICU telemedicine on patient mortality, ranking each hospital that has adopted ICU telemedicine from most effective to least effective. Second, we will conduct site visits at five hospitals with the greatest telemedicine effect and five hospitals with least telemedicine effect; along with two site visits at hospitals that have stopped using ICU telemedicine; performing in-depth qualitative analyses to identify the clinical and organizational factors associated with ICU telemedicine effectiveness. Third, we will develop and field a survey of all US hospitals that have adopted ICU telemedicine, linking the survey back to patient---level outcomes data and quantitatively defining ICU telemedicine clinical and organizational "best practices". By shifting the paradigm of ICU telemedicine evaluation away from whether it works to how and where it works best, this project will be the first rigorous examination of the factors that define successful ICU telemedicine implementation. Ultimately, these results will provide clinicians, hospital administrators with immediate, actionable data about how to use ICU telemedicine most effectively and efficiently, directly leading to improved access to critical care and improved survival for critically ill patients.

描述（由申请人提供）：由经过适当培训的重症监护医师组成的ICU治疗可提高危重患者的生存率。然而，许多患者，特别是在小医院和农村地区，无法获得这种水平的重症护理，导致死亡率过高，并造成巨大的社会经济差距。为了解决这一问题，许多医院采用了ICU远程医疗，这是一种医疗保健服务创新，利用视听技术从远处提供重症护理服务。通过扩大获得高质量重症监护的机会，ICU远程医疗在提高危重病患者的生存率方面具有巨大的潜力