The Safety and Quality of Inter-hospital Transfers for Hospitalized Adults

住院成人院间转运的安全性和质量

• 批准号: 9231441
• 负责人: Stephanie Mueller
• 金额: $ 15.54万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-01 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9231441
• 关键词: Safety; Quality; Inter; hospital; Transfers

 DESCRIPTION (provided by applicant): This is an application for a K08 Mentored Clinical Scientist Research Career Development Award for Dr. Stephanie Mueller, a medical hospitalist and researcher at Brigham and Women's Hospital (BWH) in Boston, Massachusetts. The broad goal of the work in this application is to improve the safety and quality of care transitions of hospitalized patients. More specifically, the objectives of this proposal are to identify which patients benefit and do not benefit from transfer between acute care hospitals (inter-hospital transfer, IHT) as well as define the associated risks of IHT, and use this knowledge to develop an intervention to promote safer hospital transfers. This work will be carried out in three phases. First, CMS data will be used to determine the association of IHT with several outcomes, including cost, length of stay, and mortality among different populations of patients with common diagnoses. These analyses will employ advanced epidemiologic methods to control for confounding and examine interaction of patient and hospital characteristics with IHT on patient outcomes, including Cox regression analysis, propensity score analysis, and regression analyses with effect modification. The second phase will focus solely on transferred patients to allow for an in-depth analysis of transfer process factors and patient outcomes. In this phase, we will first employ qualitative methodology to conduct and analyze interviews of a cohort of transferred patients and caregivers, to gather a more detailed understanding of reasons for transfer, expectations of care, and satisfaction with the transfer process. Then, we will utilize local hospital data to quantitatively examine a cohort of transferred patients identifying specific of the transfer process (i.e., time of day of patient arrival) and patient characteristics that are associated with increased cost, length of stay and mortality. In the third phase of this work, we will use the information gained from the first two phases and existing knowledge about safe transfer practices to develop a standardized IHT process, and conduct a pilot study using interrupted time series methods to examine the impact of this intervention on the quality of patient transfer. This information will then be used to inform development of a multi-center, cluster randomized controlled trial as a future R01 submission. Throughout the award period, coursework, strong mentorship, input from a multi-disciplinary Advisory Committee, and institutional support will advance the candidate's methodological skills in epidemiologic analysis and hospital-based outcomes research. She will also further develop her ability to translate research findings into interventions that will successfully impact the clinical care of hospitalize patients. Taken together, this multi-faceted proposal will facilitate Dr. Mueller's development int an independent investigator in hospital- based quality improvement and patient safety research.

 描述(由申请者提供)：这是为马萨诸塞州波士顿布里格姆妇女医院(BWH)的内科住院医师兼研究员斯蒂芬妮·米勒博士申请K08临床科学家导师研究职业发展奖。此应用程序中工作的广泛目标是提高住院患者的护理过渡的安全性和质量。更具体地说，这项提案的目标是确定哪些患者受益于急诊医院之间的转院(医院间转院，IHT)，以及确定IHT的相关风险，并利用这些知识制定干预措施，促进更安全的医院转院。这项工作将分三个阶段进行。 首先，CMS数据将被用来确定IHT与几种结果的相关性，包括费用、住院时间和常见诊断患者的不同人群中的死亡率。这些分析将使用先进的流行病学方法来控制混淆，并检查患者和医院特征与IHT对患者预后的交互作用，包括COX回归分析、倾向评分分析和带效果修正的回归分析。第二阶段将只关注转院患者，以便对转院过程因素和患者结果进行深入分析。在这一阶段，我们将首先使用定性方法对一组转院患者和照顾者进行访谈和分析，以更详细地了解转院的原因、对护理的期望以及对转院过程的满意度。然后，我们将利用当地医院的数据来定量检查一组转院患者，确定转院过程的具体情况(即患者到达的时间)和符合以下条件的患者特征 与增加的费用、住院时间和死亡率有关。在这项工作的第三阶段，我们将利用从前两个阶段获得的信息和现有的安全转移实践知识来制定标准化的IHT流程，并使用中断的时间序列方法进行试点研究，以检查这种干预对患者转移质量的影响。这些信息将被用来为多中心、整群随机对照试验的发展提供信息，作为未来的R01提交。在整个获奖期间，课程作业、强大的指导、来自多学科咨询委员会的投入以及机构支持将提高候选人在流行病学分析和基于医院的结果研究方面的方法技能。她还将进一步发展将研究成果转化为干预措施的能力，这些干预措施将成功地影响住院患者的临床护理。综上所述，这一多方面的建议将有助于米勒博士发展成为以医院为基础的质量改进和患者安全研究的独立调查者。