A Sleep Promotion Toolkit for Hospitalized Patients

 描述（由申请方提供）：住院患者睡眠障碍与临床相关和有害结局相关，如谵妄和福尔斯;两者均为发病率、死亡率、住院时间延长和医疗费用增加的已知风险因素。基于我们对住院患者睡眠的初步研究，并结合我们团队成员开发的其他成功的健康信息技术（IT）干预措施的设计，我们开发了一个睡眠促进工具包（SLEEPkit）的原型。使用SLEEPkit，患者在前一天晚上开始评估睡眠和睡眠干扰因素。SLEEPkit软件确定了一套与患者特定睡眠干扰因素直接相关的核心循证干预措施。然后，评估数据和相关的定制干预措施由SLEEPkit软件处理，以生成针对所有护理提供者、患者和家庭成员的睡眠和个性化教育内容的单一护理计划。SLEEPkit将被集成到现有的基于网络的患者门户网站中，并可从移动的设备（例如，iPad）在床边由患者和他们的护理伙伴。响应AHRQ PA-14-001，该R21项目的目标是通过在RE-AIM框架的指导下进行迭代改进、实施和试点评估，为SLEEPkit的开发提供信息。RE-AIM框架强调在实际临床环境中健康IT干预的范围、有效性、采用、实施和维护。具体而言，我们将1）反复完善以患者为中心的SLEEPkit，并将其作为增强功能集成到现有的基于Web的患者门户网站中; 2）在肿瘤患者护理单元中实施SLEEPkit，其中基于Web的患者门户网站目前已经到位;以及3）对SLEEPkit在住院期间对患者自我感知的整体睡眠质量的有效性进行试点测试。基于主要关注的结果，即通过PROMIS睡眠障碍测量的自我感知睡眠质量，我们计划在本初步研究中共招募120例患者。该项目的研究结果将为SLEEPkit的进一步开发和完善提供信息，其目的不仅是改善住院患者的睡眠，而且还可以很好地整合到临床和患者的工作流程中。试点评估还将为未来的随机对照试验提供研究结果的效应量，以评估SLEEPkit的应用。与AHRQ的使命一致，这将为促进住院患者睡眠的有效性和可行性奠定基础，这将最终改变目前与以下方面相关的临床实践： 患者睡眠，从而导致患者健康、结果、护理质量和成本的有意义的改善。

 DESCRIPTION (provided by applicant): Inpatient sleep disturbance has been linked to clinically relevant and detrimental outcomes such as delirium and falls; both are known risk factors for morbidity, mortality, prolonged hospital stays, and increased healthcare costs. Based on our preliminary work of inpatient sleep and incorporating the design of other successful health information technology (IT) interventions developed by our team members, we have developed a prototype of a sleep promotion tool kit (SLEEPkit). Using the SLEEPkit, patients start the assessment of sleep and sleep disturbing factors during the previous night. The SLEEPkit software identifies a core set of evidence-based interventions directly linked to the patient-specific sleep disturbing factors. The assessment data and the associated tailored interventions are then processed by the SLEEPkit software to generate a single care plan for sleep and personalized educational content for all care providers, patients, and family members. The SLEEPkit will be integrated into an existing web-based patient portal and easily accessed from mobile devices (e.g., iPad) at the bedside by patients and their care partners. Responding to the AHRQ PA-14-001, the goal of this R21 project is to inform the development of the SLEEPkit by conducting iterative refinement, implementation, and pilot evaluation guided by the RE-AIM framework. The RE- AIM framework emphasizes the Reach, Effectiveness, Adoption, Implementation, and Maintenance of a health IT intervention in the actual clinical setting. Specifically, we will 1) iteratively refine a patient-centered SLEEPkit and integrate it as an enhancement into an existing web-based patient portal; 2) To implement the SLEEPkit on an oncology patient-care unit where the web-based patient portal is currently in place; and 3) To pilot test the effectiveness of the SLEEPkit on patient's self-perceived overall sleep quality during hospitalization. Based on the primary outcome of interest, self-perceived sleep quality measured by the PROMIS Sleep Disturbance, we plan to enroll a total of 120 patients for this pilot study. Findings of this project will inform further development and refinement of the SLEEPkit, which aims not only to improve inpatient sleep but also to be well integrated to clinical and patient workflow. The pilot evaluation will also inform the effect size of study outcomes for a future randomized controlled trial to evaluate the SLEEPkit application. Consistent with the AHRQ mission, this will lay the groundwork for making inpatient sleep promotion effective and feasible, which will ultimately change current clinical practice related to patient sleep, hence leading to meaningful improvement in patient health, outcomes, quality of care, and cost.