Improving How Older Adults at Risk for Cardiovascular Outcomes Are Selected for Care Coordination

改善如何选择有心血管结局风险的老年人进行护理协调

• 批准号: 10708918
• 负责人: Lisa M Kern
• 金额: $ 19.54万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2024-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10708918
• 关键词: Improving; How; Older; Adults; Risk

Medicare beneficiaries ≥65 years old who are at risk for incident or recurrent cardiovascular events often have physiologic problems affecting multiple organ systems, which can lead to receiving ambulatory care from providers in different specialties. Although receiving care from multiple providers may be clinically appropriate, gaps in communication among providers are common, which can be hazardous for patients. Accountable care organizations (ACOs) often employ “care coordinators” (typically with backgrounds in nursing or social work) who facilitate communication among the individuals involved in a patient’s care. However, ACOs typically have thousands of patients and only a few care coordinators. How to optimally allocate care coordinators is not known. The usual approach has been to assign care coordinators to patients after a hospital discharge. While this is reasonable, it assumes that all discharged patients need care coordination (which they may not), and it has the disadvantage of waiting until after a hospitalization has occurred. Meanwhile, patients are often aware of when their care is not being well coordinated, yet no existing intervention leverages these observations. A pilot randomized controlled trial will determine the comparative effectiveness of two approaches for assigning care coordinators to patients: (a) a novel patient-centered approach that assigns care coordinators to those who perceive a problem with care coordination vs. (b) usual care (i.e., after hospital discharge). The Research Aims are to: (1) determine the comparative effectiveness of these two approaches on the combined outcome of emergency department visit or hospitalization over 12 months of follow-up, and (2) measure implementation outcomes (acceptability, appropriateness, fidelity, and efficiency) to inform a future multi-center randomized controlled trial. The pilot trial will include Medicare beneficiaries ≥65 years old (N = 400 total, or 200 per trial arm) who are attributed to an ACO, have cardiovascular disease or ≥1 cardiovascular risk factors, and had highly fragmented ambulatory care in the past year (as a risk factor for gaps in communication). Lisa Kern, MD, MPH (PI) is an Associate Professor of Medicine and health services researcher who is expert in ambulatory care quality and who has spent her career to date conducting independent evaluations of others’ interventions and observational studies of her own. This K18 AHRQ Mentored Career Enhancement Award for Established Investigators in Patient-Centered Outcomes Research would allow Dr. Kern to transition to a career of designing, implementing, and evaluating her own interventions, through learning pragmatic clinical trials (Training Aim 1) and implementation science (Training Aim 2). Dr. Kern’s mentoring team has expertise in pragmatic clinical trials, implementation science, care coordination, cardiovascular disease, and biostatistics. The proposed work has the potential to improve ambulatory care and improve patient outcomes.

联邦医疗保险受益人≥65岁，有突发或复发心血管事件风险的人通常 影响多个器官系统的生理问题，可能导致接受来自 不同专业的提供者。尽管从多个提供者接受护理在临床上可能是合适的， 提供者之间的沟通差距很常见，这可能会对患者造成危险。负责任的护理 组织(ACO)通常雇佣“护理协调员”(通常具有护理或社会工作背景) 他们促进了参与病人护理的个人之间的沟通。然而，ACO通常有 数以千计的病人和只有几个护理协调员。如何最优地分配护理协调员不是 为人所知。通常的做法是在出院后为患者指派护理协调员。而当 这是合理的，它假设所有出院的病人都需要护理协调(他们可能不需要)，而且它 有一个缺点，那就是要等到住院后才能使用。与此同时，患者通常会意识到 当他们的护理没有得到很好的协调时，但现有的干预措施没有利用这些观察到的情况。 一项试点随机对照试验将确定两种分配方法的比较有效性 病人护理协调员：(A)以病人为中心的新方法，将护理协调员指派给 他们认为护理协调与(B)常规护理(即出院后)存在问题。研究报告 目的是：(1)确定这两种方法对合并结果的相对有效性 超过12个月的急诊科就诊或住院情况，以及(2)措施执行情况 结果(可接受性、适当性、保真度和效率)来通知未来的多中心随机 对照试验。试点试验将包括65岁的联邦医疗保险受益人≥(N=总计400人，或每次试验200人 ARM)，有心血管疾病或≥1心血管危险因素，并有 过去一年高度分散的门诊护理(作为沟通差距的一个风险因素)。 丽莎·克恩，医学博士，公共卫生硕士(PI)，医学副教授和卫生服务研究员，专家 在门诊护理质量方面，到目前为止，她的职业生涯一直在对其他人的 她自己的干预和观察性研究。本年度K18 AHRQ职业提升导师奖 以患者为中心的结果研究中的老牌研究人员将使克恩博士过渡到 通过学习实用临床，设计、实施和评估自己的干预措施 试验(培训目标1)和实施科学(培训目标2)。克恩博士的指导团队在 务实的临床试验、实施科学、护理协调、心血管疾病和生物统计学。 拟议的工作具有改善门诊护理和改善患者预后的潜力。