Determining Key Organizational Health Communication Practices in Complex Patients

描述（由申请人提供）：有效的沟通是以患者为中心的护理的重要组成部分。新出现的证据表明，良好的组织沟通，或医疗保健系统的组成部分内部和之间的健康沟通实践，是提供高质量，可靠和安全的病人为中心的护理是必不可少的。推进研究，以确定组织沟通和病人的结果之间的关系是必要的和关键的，以促进沟通评估纳入常规的卫生系统自我评估和质量监测。本提案的目标是推进对与健康相关的组织沟通实践的实践、决定因素和相关患者结局的评估和理解。终末期肾病（ESRD）和提供维持生命的透析治疗提供了一个独特而强大的环境，以检查透析机构的组织沟通及其对患者结局的影响。ESRD患者的死亡率、住院率和生活质量均显著较高。尽管透析护理技术取得了进步，但结局持续不佳，这表明有机会采取新的策略来改善患者的医疗保健。总的来说，我们假设组织沟通有助于显着个人患者的结果，设施级的质量指标，也可以克服弱势患者群体之间的结果的差异。作为该提案的一部分，我们将利用透析结局和实践模式研究（DOPPS）的资源，DOPPS是自1996年以来在21个国家进行的代表性前瞻性国际队列研究，旨在确定与改善患者结局相关的可修改实践。为了解决我们的假设，本提案的目的是：1）通过对100家透析机构和700名血液透析患者的现有措施进行调整、管理和验证，来表征透析机构中组织沟通的质量; 2）在465家透析机构和15家，3）确定透析机构组织沟通是否会改变年龄、种族或健康素养相关差异与临床或患者报告结局的相关性。我们是一个综合的，多样化的研究团队，装备精良，独特的准备，有效地利用现有的基础设施，显着推进健康传播研究。重要的是，我们还与一个深厚的国家和国际资源网络相连，以确保将我们的研究结果传播给广大受众。本研究将有助于未来的研究，推进沟通评估的方法，也是我们的透析护理组织沟通的机制的理解。最重要的是，这项研究将为未来开发和测试高效和有效的多层次干预措施提供信息，以连接患者，提供者和卫生系统，以优化质量计划和以患者为中心的护理。

DESCRIPTION (provided by applicant): Effective communication is an essential component of patient-centered care. Emerging evidence suggests that favorable organizational communication, or the health communication practices within and between constituents of a healthcare system, is essential to the delivery of high quality, reliable and safe patient- centere care. Advancing research to determine the relationship between organizational communication and patient outcomes is necessary and critical to promote the integration of communication assessment into routine health system self-evaluation and quality monitoring. The goal of this proposal is to advance the assessment and understanding of the practices, determinants and associated patient outcomes of health- related organizational communication practices. End-stage renal disease (ESRD) and the provision of life- sustaining dialysis treatment provides a unique and robust environment to examine dialysis facility organizational communication and its impact on patient outcomes. Patients with ESRD are at significantly higher risk for mortality, hospitalization, and poor quality of life. Despite advances in the technology of dialysis care, outcomes are persistently poor indicating opportunities for novel strategies to improve patient healthcare. Overall, we hypothesize that organizational communication contributes significantly to individual patient outcomes, facility-level quality metrics, and also may overcome disparities in outcomes among vulnerable patient populations. As part of this proposal we will leverage the resources of the Dialysis Outcomes and Practice Patterns Study (DOPPS), a representative prospective international cohort study since 1996, in 21 countries, aimed to identify modifiable practices associated with improved patient outcomes. To address our hypothesis, the aims of this proposal are: 1) To characterize the quality of organizational communication in dialysis facilities by adapting, administering and validating an existing measure in 100 facilities and 700 hemodialysis patients; 2) To examine in a prospective cohort the association of organizational communication with clinical and patient-reported outcomes in 465 dialysis facilities and 15,000 patients worldwide; and 3) To determine if dialysis facility organizational communication modifies associations of age, race, or health-literacy related disparities and clinical or patient-reported outcomes. We are an integrated, diverse research team well equipped and uniquely poised to efficiently leverage existing infrastructure to significantly advance health communication research. Importantly, we are also connected to a deep network of national and international resources to ensure dissemination of our findings to a broad audience. This research will serve future research by advancing methodology of communication assessment and also our understanding of mechanisms of organizational communication in dialysis care. Most importantly, this research will inform the future development and testing of efficient and effective multi-level interventions to connect patients, providers and health systems to optimize quality programs and patient-centered care.