Testing biopsychosocial mechanisms of the posthospital syndrome model of early rehospitalization in acute coronary syndrome patients

测试急性冠脉综合征患者早期再住院的院后综合征模型的生物心理社会机制

• 批准号: 9406011
• 负责人: Donald Edmondson
• 金额: $ 21.76万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-01-01 至 2019-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9406011
• 关键词: Accident and Emergency department; Acute; Acute Disease; Admission activity; Affordable Care Act; Aging; Biological Markers; Body Weight decreased; Cardiac; Caring; Characteristics; Comorbidity; Data; Distress; Ecological momentary assessment; Emergency department crowding; Enrollment; Environment; Environmental Risk Factor; Event; Goals; Health; Hospitalization; Hospitals; Hour; Intervention; Intuition; Length of Stay; Light; Lighting; Measures; Mediating; Modeling; Monitor; Myocardial Infarction; Noise; Outcome; Patients; Personality; Physical activity; Physicians; Politics; Population; Process; Psychological Stress; Public Health; Regulation; Reporting; Research; Research Personnel; Risk; Risk Factors; Risk stratification; Severities; Sleep; Social support; Stress; Syndrome; Testing; Time; Unstable angina; Voice; actigraphy; acute coronary syndrome; base; biopsychosocial; cohort; design; experience; high risk; hospital readmission; improved; indexing; pressure; public health relevance; therapy design

 DESCRIPTION (provided by applicant): The hospital environment was designed for treatment of acute illnesses, and has evolved unsystematically over the past century based on financial, demographic, and political pressures. We have become expert at treating acute cardiac events in particular, but new evidence suggests that hospitalization itself may weaken our patients -- rendering them susceptible to a host of maladies while they recover. A recent study of 500,000 cardiac admissions found that 1 out of every 5 patients was rehospitalized within 30 days of their discharge. Surprisingly, only half of those rehospitalizations were for cardiac reasons. Because of new financial regulations in the Affordable Care Act that tie reimbursement to rehospitalization rates, hospitals are highly motivated to decrease these early rehospitalizations. A new model of "posthospital syndrome" (PHS) suggests that the stress of hospitalization itself confers increased risk of rehospitalization because it places patients in a transient state of generalized risk. Testing this model, and identifying hospital environment and patient factors that place patients at risk, are crucial for directing hospital efforts to reduce 30-day rehospitalizations. The first goal of this proposed research is to test the PHS model to explain the high risk of all-cause rehospitalization experienced by cardiac patients in the 30 days after they are discharged. The second goal is to identify modifiable hospital factors that contribute most to PHS, and by doing so detect targets for reducing early hospital readmissions. The third goal is to identify patient factors, such as personality and social support that may be associated with PHS, so that we can ultimately conduct risk stratification and improve patients' successful transition to independent post-hospital care. We plan to enroll a consecutive cohort of 1,000 cardiac patients who are admitted through the emergency department (ED), follow them throughout their hospitalization, and identify 30-day rehospitalizations. We will assess 4 in-hospital risk factors: stress using ecological momentary assessment (EMA); sleep and physical activity by actigraphy; and weight loss by electronic scale. We will also objectively assess hospital factors that may contribute to stress: stressful environmental factors (degree of ED crowding and length of stay [LOS]; excess noise and lighting throughout hospitalization). Further, we will measure patient factors that may influence the hospital experience, including personality, social support, cardiac severity, and physical and psychiatric comorbidities during and after hospitalization. Finally, we will test whether in-hospital stress (and secondarily, physical activity, sleep, or weight loss) contribute to 30-day rehospitalizations. More than 1 million cardiac patients are hospitalized in the US annually, and 20% are rehospitalized within 30 days. All of the factors that have been hypothesized to contribute to PHS are modifiable, but evidence of their association to rehospitalization is required to motivate change. This study would be the first to test whether change is warranted, and to provide targets for intervention. As such, the impact of this research is substantial.

 描述（由申请人提供）：医院环境是为治疗急性疾病而设计的，在过去的世纪里，由于经济、人口和政治压力，医院环境没有系统地发展。我们已经成为治疗急性心脏病的专家，但新的证据表明，住院治疗本身可能会削弱我们的病人-使他们在康复期间容易患上一系列疾病。最近一项对50万例心脏病住院患者的研究发现，每5名患者中就有1名在出院后30天内再次住院。令人惊讶的是，只有一半的再住院是因为心脏原因。由于《平价医疗法案》中新的财务规定将报销与再住院率挂钩，医院非常积极地减少这些早期再住院。 一种新的“产后综合征”（PHS）模型表明，住院本身的压力会增加再住院的风险，因为它使患者处于短暂的广义风险状态。测试这一模型，并确定医院环境和患者因素，使患者处于危险之中，是指导医院努力减少30天再住院的关键。这项拟议研究的第一个目标是测试PHS模型，以解释心脏病患者在出院后30天内经历的全因再住院的高风险。第二个目标是确定对PHS贡献最大的可修改的医院因素，并通过这样做来检测减少早期再入院的目标。第三个目标是确定可能与PHS相关的患者因素，如个性和社会支持，以便我们最终进行风险分层，提高患者成功过渡到独立的院后护理。我们计划连续招募1,000名通过急诊科（艾德）入院的心脏病患者，在他们住院期间对其进行随访，并确定30天的再住院。我们将评估4个住院风险因素：使用生态瞬时评估（EMA）评估压力;通过腕动记录仪进行睡眠和身体活动;通过电子秤进行体重减轻。我们还将客观地评估可能导致压力的医院因素：压力环境因素（艾德拥挤程度和住院时间[LOS];住院期间过度的噪音和照明）。此外，我们将测量可能影响住院体验的患者因素，包括个性，社会支持，心脏严重程度以及住院期间和住院后的身体和精神共病。最后，我们将测试住院压力（其次是体力活动、睡眠或体重减轻）是否会导致30天的再住院。美国每年有超过100万心脏病患者住院，其中20%在30天内再次住院。所有被假设为导致PHS的因素都是可以改变的，但需要有证据表明它们与再住院有关，以激励改变。这项研究将是第一个测试是否有必要改变，并提供干预目标的研究。作为 所以这个研究的影响是很大的。