Enhancing Inter-Facility Transfer for Patients with Acute Myocardial Infarction

加强急性心肌梗死患者的机构间转运

• 批准号: 9405604
• 负责人: Michael J. Ward
• 金额: $ 15.67万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 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/9405604
• 关键词: Accident and Emergency department; Acute myocardial infarction; Address; Affect; Award; Behavior; Benchmarking; Biometry; Businesses; Cardiovascular system; Caring; Case Study; Characteristics; Clinical; Communication; Complex; Data; Development; Development Plans; Diagnosis; Doctor of Philosophy; Elements; Emergency Department Physician; Ensure; Environment; Evaluation; Event; Foundations; Funding; Future; Goals; Grant; Health system; Healthcare Systems; Hospitals; Individual; International; Intervention; Interview; K-Series Research Career Programs; Knowledge; Lead; Manuscripts; Maps; Measurement; Measures; Mentors; Methods; Modeling; Myocardial Infarction; Myocardial Reperfusion; Organizational Culture; Outcome; Patient Care; Patient Transfer; Patient-Focused Outcomes; Patients; Performance; Play; Positioning Attribute; Preparation; Process; Public Health; Qualitative Methods; Qualitative Research; Reperfusion Therapy; Research; Research Personnel; Role; Science; Source; Surveys; System; Testing; Time; Training; United States; United States Agency for Healthcare Research and Quality; Variant; Writing; care coordination; care delivery; care outcomes; career development; design; effective intervention; experience; field study; improved; improved outcome; instrument; interdisciplinary approach; mortality; multidisciplinary; novel; operation; percutaneous coronary intervention; programs; public health relevance; skills; symposium; theories; therapy development; time interval; trial design

 DESCRIPTION (provided by applicant): In the U.S., nearly 500,000 patients suffer an ST-elevation myocardial infarction (STEMI) each year. Most emergency departments (EDs) lack the local capabilities to perform primary percutaneous coronary intervention (PCI) for myocardial reperfusion. Thus, patients must be transferred to capable facilities, but inefficiencies in this process cause delays in timely myocardial reperfusion and worsen patient outcomes. The time to reperfusion for transferred STEMI patients greatly lags behind those patients who present directly to PCI centers and fails to meet national benchmark standards in 90% of cases. Inadequate measurement and understanding of the timing and processes of care at transferring EDs has hindered improvement in the timeliness of STEMI patient transfer. Moreover, the study of relational coordination, communication, and organizational design, collectively known as "organizational behavior," is an accepted approach to study performance and variation in complex health systems. It has not yet been applied to the transfer of STEMI patients, but would likely reveal important targets for intervention. This proposal describes a career development plan that enables the candidate to gain expertise in how organizational behavior affects patient care, through the acquisition of advanced qualitative and quantitative skills for future implementation studies. The Specific Aims are: 1) Examine transferring ED data for factors associated with delays to myocardial reperfusion; 2) Conduct a detailed qualitative study of the practices that affect patient transfer for primary PCI; and 3) Examine the association between relational coordination and time spent at transferring EDs. The candidate is uniquely qualified as an emergency physician and PhD candidate in operations management. The career development plan builds on this foundation to provide: a) advanced skills in qualitative methods (e.g., patient and staff interviewing skills, and observation), biostatistics, and organizational theory; b) further development of scientific communication skills through manuscript preparation, grant writing, and conference presentations; and c) a multidisciplinary mentored research experience with international experts in transitions of care, qualitative research, process intervention development, and trial design. The institutional environment is outstanding, including a qualitative research center; nationally ranked graduate programs in the candidate's fields of study; and the national CTSA coordinating center. This career development award will allow the candidate to develop expertise in measuring the performance of healthcare systems during inter-facility patient transfer, a deep understanding of the relationship between system performance and patient outcomes, and targets for intervention to improve the timeliness of patient care for myocardial infarction. This award will position the candidate to become an R01-funded independent investigator who implements and evaluates process interventions to improve patient outcomes.

 描述（由申请人提供）：在美国，每年有近 500,000 名患者患有 ST 段抬高型心肌梗死 (STEMI)。大多数急诊科 (ED) 缺乏进行直接经皮冠状动脉介入治疗 (PCI) 进行心肌再灌注的本地能力。因此，患者必须转移到有能力的设施，但这一过程的低效率会导致及时心肌再灌注的延迟并恶化患者的预后。转院STEMI患者的再灌注时间大大落后于直接到PCI中心就诊的患者，并且90%的病例未能达到国家基准标准。对转移急诊室的护理时间和流程的测量和理解不足阻碍了 STEMI 患者转移及时性的提高。此外，对关系协调、沟通和组织设计（统称为“组织行为”）的研究是研究复杂卫生系统绩效和变化的公认方法。它尚未应用于 STEMI 患者的转移，但可能会揭示重要的干预目标。该提案描述了一项职业发展计划，使候选人能够通过获得未来实施研究的高级定性和定量技能，获得组织行为如何影响患者护理的专业知识。具体目标是： 1) 检查传输 ED 数据中与心肌再灌注延迟相关的因素； 2) 对影响直接 PCI 患者转移的做法进行详细的定性研究； 3) 检查关系协调与转移 ED 所花费的时间之间的关联。该候选人具有作为急诊医师和运营管理博士候选人的独特资格。职业发展计划在此基础上提供： a) 定性方法（例如患者和工作人员访谈技巧和观察）、生物统计学和组织理论方面的高级技能； b) 通过手稿准备、资助写作和会议演讲进一步发展科学沟通技能； c) 在护理转变、定性研究、过程干预开发和试验设计方面拥有由国际专家指导的多学科研究经验。机构环境优越，包括定性研究中心；候选人研究领域的全国排名研究生课程；以及国家 CTSA 协调中心。该职业发展奖将使候选人能够发展在设施间患者转移过程中衡量医疗保健系统性能的专业知识，深入了解系统性能与患者结果之间的关系，以及提高心肌梗死患者护理及时性的干预目标。该奖项将使候选人成为一名由 R01 资助的独立研究者，负责实施和评估过程干预措施以改善患者的治疗结果。