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.

脓毒症是一种以急性器官功能障碍和失调为特征的危及生命的疾病 继发于感染的免疫反应。与其他疾病相比，住院30天 脓毒症后的再入院率一直很高，从17%到35%不等。之间 再次入院的家庭健康败血症幸存者中，32%发生在前7天内。我们的工作 结果表明，败血症幸存者的30天再入院率低7个百分点， 接受包括及时的家庭健康（HH）和门诊护理的方案。值得注意的是， 全国170，500名败血症幸存者中只有28%接受了该方案。我们目前的NINR资助 实施科学研究，I-TRANSFER（R 01 NR 016014）正在实施本方案。这 补充将扩大我们对议定书背后的行动机制的理解- 从病人和照顾者的角度来看， 了解如何促进及时启动和采用HH的行为， 门诊护理。健康与疾病自我调节的常识模型（CS-SRM） 将指导我们探索与患者和护理人员对脓毒症的看法有关的MOA， 及时进行HH和门诊访视的理由。该模型假设，应对策略，如 如寻求医疗照顾，是通过认知和情感疾病形成的， 基于情境刺激的八个维度的表征，例如，症状与知识 目标1。定量比较脓毒症的患者疾病表现（例如，后果， 个人控制，身份，关注，理解）在两组脓毒症幸存者中： 有和没有完全遵守协议;控制健康的社会决定因素（SDH）。 目标2. Qualitiment探索CS-SRM维度与患者的相似性和差异性 和他们的照顾者从两个协议组，以及替代行为相关的因素 (e.g., SDH、交通、门诊就诊共同负担费用），有助于及时的HH和门诊护理。 在脓毒症人群中从未研究过患者和护理人员的疾病感知， 来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提案，以开发和测试病人， 护理人员干预，以改善与接受急性后 治疗本申请符合NOT-OD-23-083的具体要求。