Engaging Patients and Providers in Identifying and Addressing Modifiable Risk Factors to Prevent Community-Acquired Ulcers in Veterans with SCI

让患者和医疗服务提供者参与识别和解决可改变的风险因素，以预防患有 SCI 的退伍军人出现社区获得性溃疡

• 批准号: 10213831
• 负责人: Elizabeth Burkhart
• 金额: --
• 依托单位: EDWARD HINES JR VA HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10213831
• 关键词: Activities of Daily Living; Address; Admission activity; Adoption; Advisory Committees; Affect; Ambulatory Care Facilities; Automobile Driving; Behavior; Caregivers; Caring; Case Study; Clinic; Clinical; Communities; Community based prevention; Data; Denervation; Documentation; Education; Ensure; Equipment; Fostering; Future; Goals; Habits; Health; Health Care Costs; Healthcare Systems; Home; Hospitals; Hour; Incidence; Independent Living; Individual; Inpatients; Institution; Intervention; Interview; Knowledge; Learning; Length of Stay; Life; Life Style; Logic; Methods; Modeling; Morbidity - disease rate; Motor; Numbness; Nursing Homes; Outpatients; Paraplegia; Patients; Perception; Persons; Plant Roots; Prevalence; Prevention; Prevention Guidelines; Prevention education; Prevention strategy; Preventive; Preventive care; Preventive service; Process; Protocols documentation; Provider; Psyche structure; Quadriplegia; Quality of life; Recommendation; Recurrence; Regimen; Reporting; Research Methodology; Resources; Risk; Risk Assessment; Risk Factors; Site; Skin; Skin Care; Spinal cord injury; Standardization; Testing; Translating; Ulcer; Veterans; Walking; Work; acute care; chronic care model; cohort; community based participatory research; community center; community setting; complex chronic conditions; compliance behavior; cost; decubitus ulcer; evidence base; experience; feasibility trial; healing; high risk; improved; member; modifiable risk; mortality; patient oriented; pressure ulcer prevention; prevent; programs; satisfaction; shared decision making; support tools; tool

The objective of this study is to identify and begin to address the challenges of preventing community- acquired pressure ulcer (CAPrUs) in individuals living with spinal cord injury (SCI) by exploring patient, caregiver, and provider perceived risk factors. We will explore Veteran and caregiver perceptions of CAPrU risk factors using participatory action research [PAR] (photovoice, guided tour) methods and provider perspectives with individual interviews. We will compare SCI providers' perceptions of CAPrU risk factors with those of Veterans and caregivers. We will conduct a Delphi panel with expert panel members to develop, and pilot a risk assessment checklist tool for CAPrUs in an SCI outpatient clinic. Our current health care system is fragmented and well-established HAPrU prevention strategies have not been defined, translated, expanded on or adapted to the outpatient setting, nor have actions and community resources been identified to support ulcer prevention activities in the community. Our study rationale builds on the same logic underlying the U.S. Preventive Services Task Force (USPSTF) recommendations1 and the IOM report, “To Err Is Human” promote developing evidence-based decision support tools to foster meaningful patient-centered productive interactions,2,3 Productive interactions in preventing CAPrUs begin by engaging patient and provider in identifying modifiable risk factors, actions and resources. The proposed checklist is the means for identifying CAPrU risks, actions and resources to stimulate prevention activities in the community. Aims 1 & 2 focus on ensuring the checklist is patient-centered, addresses gaps between the patient and provider perspectives, and is practical and relevant for the community setting. Aim 3 will evaluate whether integrating the checklist into SCI outpatient encounters increases the provision/receipt of CAPrU preventive care and its' impact on new CAPrUs. Our proposed CAPrU checklist is the bridge for patient-provider mutual goal setting in the clinic and for driving prevention activities in the community. We will identify actions and resources needed to operationalize the existing PrU prevention guidelines to community/home settings by: 1) identifying and comparing stakeholder (patient, caregiver, provider) mental models of the challenges in addressing CAPrU risk factors, 2) convening an expert panel of stakeholders (e.g., Veterans, caregivers, providers, and national PrU prevention experts) to develop and validate a risk factor checklist tool that includes specific actions and resources needed to prevent CAPrUs, and 3) evaluating the risk factor checklist tool in an outpatient SCI clinic to determine the feasibility, acceptability, efficacy and integration into work/patient flow in an SCI outpatient clinic. Guided by the USPSTF recommendations and the Wagner Chronic Care Model for improving management of complex chronic conditions, we will create a risk assessment decision support tool to identify risks, actions and resources to promote productive interactions between patients, caregivers and providers. We will use mixed methods to create the tool and conduct a pre-post feasibility trial of that tool in an SCI outpatient clinic. [We will also examine the effect of the tool on new CAPrU incidence at all 3 study sites.] Study products include: 1) an iPad application that automates the risk factor checklist tool and supports provider documentation of risk factors and PrU preventive actions, specific actions and resources needed to prevent CAPrUs for use in the outpatient clinic; 2) a study protocol for implementing the iPad checklist tool during SCI outpatient encounters; and 3) case studies to inform Veterans and SCI providers about risk factors associated with new CAPrUs. This study will create a more consistent approach to CAPrU risk factors and preventive care to be evaluated in a future study.

本研究的目的是确定并开始应对预防社区- 脊髓损伤（SCI）患者的获得性压疮（CAPrU）， 护理人员和供应商感知的风险因素。我们将探讨退伍军人和护理人员对CAPrU的看法 使用参与性行动研究[PAR]（照片语音，导游）方法和提供者的风险因素 个人访谈的观点。我们将比较SCI提供者对CAPrU风险因素的看法， 那些退伍军人和照顾者。我们将与专家小组成员一起进行德尔菲小组的开发， 在SCI门诊诊所为CAPrU试行风险评估清单工具。 我们目前的卫生保健系统是分散的，完善的HAPrU预防战略 没有被定义，翻译，扩大或适应门诊设置，也没有行动和社区 已物色资源，以支援社区预防溃疡活动。我们的研究原理建立在 美国预防服务工作组（USPSTF）声明1和国际移民组织（IOM） 报告，“犯错是人类”促进开发基于证据的决策支持工具，以促进有意义的 以患者为中心的有效互动，2，3预防CAPrU的有效互动开始是通过参与 患者和提供者在识别可修改的风险因素，行动和资源。建议的清单是 确定CAPrU风险、行动和资源的手段，以促进社区的预防活动。 目标1和2侧重于确保检查表以患者为中心，解决患者与 供应商的观点，是实用的，并为社区设置相关。目标3将评估是否 将检查表整合到SCI门诊就诊中，增加了CAPrU预防性护理的提供/接受 及其对新CAPrU的影响。我们提出的CAPrU清单是患者-提供者共同目标的桥梁 在诊所设置和推动社区预防活动。 我们将确定实施现有PrU预防指南所需的行动和资源 社区/家庭环境：1）识别和比较利益相关者（患者，护理人员，提供者）的心理 应对CAPrU风险因素的挑战模型，2）召集利益相关者专家小组（例如， 退伍军人、护理人员、提供者和国家PrU预防专家），以制定和验证风险因素 清单工具，包括防止CAPrU所需的具体行动和资源，以及3）评估 危险因素检查表工具在门诊SCI诊所，以确定可行性，可接受性，有效性和 整合到SCI门诊诊所的工作/患者流程中。 在USPSTF建议和瓦格纳慢性病护理模式的指导下， 管理复杂的慢性病，我们将创建一个风险评估决策支持工具，以确定 风险、行动和资源，以促进患者、护理人员和提供者之间的富有成效的互动。 我们将使用混合方法来创建工具，并在SCI中对该工具进行前后可行性试验 门诊[We还将检查该工具对所有3个研究中心新的CAPrU发生率的影响。] 研究产品包括：1）一个iPad应用程序，自动化风险因素检查表工具，并支持 提供风险因素和PrU预防措施、具体措施和所需资源的文件， 防止在门诊诊所使用CAPrU; 2）实施iPad检查表工具的研究方案 在SCI门诊遇到;和3）案例研究，告知退伍军人和SCI供应商有关风险因素 与新的CAPrU相关。这项研究将为CAPrU风险因素创造一种更一致的方法， 在未来的研究中进行评估。