I-TRANSFER Improving TRansitions ANd outcomeS oF sEpsis suRvivors

I-TRANSFER 改善脓毒症幸存者的转变和结果

• 批准号: 10824878
• 负责人: Kathryn Helene Bowles
• 金额: $ 40.57万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-24 至 2025-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10824878
• 关键词: Acute; Address; Adherence; Administrative Supplement; Adoption; Affect; Ambulatory Care; Applications Grants; Appointment; Behavior; Behavioral; Care given by nurses; Caregivers; Chronic Disease; Clinical; Cognitive; Coping Skills; Data; Decision Making; Dimensions; Disease; Effectiveness; Emotional; Enrollment; Functional disorder; Funding; Future; Health; Health Promotion; Home; Home Care Services; Home Health Agency; Hospitals; Immunologic Memory; Infection; Informal Social Control; Insurance; Intervention; Investigation; Knowledge; Length of Stay; Life; Medical; Modeling; Nurses; Operative Surgical Procedures; Organ; Outcome; Outpatients; Patients; Perception; Population; Prevention; Protocols documentation; Relapse; Research; Research Proposals; Resources; Role; Secondary to; Sepsis; Services; Severities; Social Controls; Stimulus; Survivors; Symptoms; Testing; Transportation; Visit; Work; acute care; behavior influence; behavioral adherence; caregiver interventions; copayment; ethnic disparity; follow-up; health equity; high risk; hospital readmission; illness perceptions; implementation science; improved; informal caregiver; insight; medical attention; prevent; racial disparity; readmission rates; readmission risk; septic patients; social health determinants; theories

Sepsis is a life-threatening disease characterized by acute organ dysfunction and dysregulated immune response secondary to infection. Compared to other illnesses, 30-day hospital readmission rates after sepsis are consistently high, ranging from 17% to 35%. Among readmitted home health sepsis survivors, 32% occurred within the first 7 days. Our work demonstrated that 30-day readmission rates are 7 percentage points lower in sepsis survivors who receive a protocol that includes both timely home health (HH) and outpatient care. Notably, only 28% of 170,500 sepsis survivors nationally received this protocol. Our current NINR funded implementation science study, I-TRANSFER (R01NR016014) is implementing this protocol. This supplement will broaden our understanding of the mechanisms of action (MOA) behind protocol- adherence behaviors from the patients' and caregivers' perspectives and increase our knowledge of how to facilitate behavior toward initiation and adoption of timely HH and outpatient care. The Common-sense Model of Self-regulation of Health and Illness (CS-SRM) will guide our exploration of MOA that relate to patient and caregiver perceptions of sepsis and rationale toward timely HH and outpatient visits. The model posits that coping strategies, such as seeking medical attention, are formed through the cognitive and emotional illness representations in eight dimensions based on situational stimuli, e.g., symptoms and knowledge. Aim 1. Quantitatively compare patient illness representations of sepsis (e.g., consequences, personal control, identity, concern, understanding) among two groups of sepsis survivors: those with and without full protocol adherence; controlling for social determinants of health (SDH). Aim 2. Qualitatively explore similarities and differences in CS-SRM dimensions with patients and their caregivers from the two protocol groups, as well as alternative behavior-related factors (e.g., SDH, transportation, outpatient visit copays) contributing to timely HH and outpatient care. Patient and caregiver illness perceptions have never been studied in the sepsis population, nor to promote these important interventions. The results of the proposed study will inform intervention adherence and will support a future grant proposal to develop and test a patient and caregiver intervention to improve decision-making behaviors related to acceptance of post-acute treatment. This application meets the specific requests of NOT-OD-23-083.

败血症是一种威胁生命的疾病，其特征是急性器官功能障碍和功能失调 继发于感染的免疫反应。与其他疾病相比 败血症后的再入院率始终高，范围从17％到35％。之中 已恢复的家庭健康败血症幸存者，在前7天内发生了32％。我们的工作 证明败血症幸存者的30天再入院率降低了7个百分点 他们获得包括及时家庭健康（HH）和门诊护理的协议。尤其， 在全国范围内，只有170,500名败血症幸存者中只有28％获得了该协议。我们目前的忍者资助 实施科学研究，I-Transfer（R01NR016014）正在实施此协议。这 补充将扩大我们对协议背后的作用机理（MOA）的理解 - 从患者和照顾者的角度遵守行为，并增加了我们的 了解如何促进行为启动和采用及时的HH和 门诊护理。健康和疾病自我调节的常识模型（CS-SRM） 将指导我们对MOA的探索，该探索与患者和照顾者对败血症的看法有关 及时的HH和门诊就诊的理由。该模型认为应对策略，例如 作为寻求医疗护理，是通过认知和情感疾病形成的 基于情境刺激（例如症状和知识）的八个维度表示。 目标1。定量比较败血症的患者疾病表征（例如，后果， 个人控制，身份，关心，理解）在两组败血症幸存者中： 有和没有完整的协议依从性；控制健康的社会决定因素（SDH）。 目标2。定性地探索与患者CS-SRM维度的相似性和差异 以及他们的护理人员来自两个方案组，以及替代性行为相关的因素 （例如，SDH，运输，门诊就诊），为及时的HH和门诊护理做出贡献。 败血症人群从未研究过患者和护理人员疾病的看法，也从未研究过 促进这些重要的干预措施。拟议研究的结果将告知 干预依从性，并将支持未来的赠款建议，以开发和测试患者， 护理人员干预以改善与接受后接受有关的决策行为 治疗。本申请符合NOT-OD-23-083的特定请求。