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

 描述（由申请人提供）：这是一份为马萨诸塞州波士顿布里格姆妇女医院（BWH）的医学住院医师和研究员Stephanie Mueller博士申请K08指导临床科学家研究职业发展奖的申请。该应用程序中工作的主要目标是提高住院患者护理过渡的安全性和质量。更具体地说，本提案的目标是确定哪些患者受益于和不受益于急症护理医院之间的转移（医院间转移，IHT），以及定义IHT的相关风险，并利用这些知识制定干预措施，以促进更安全的医院转移。这项工作将分三个阶段进行。 首先，CMS数据将用于确定IHT与几种结局的相关性，包括具有常见诊断的不同患者人群的费用，住院时间和死亡率。这些分析将采用先进的流行病学方法来控制混杂因素，并检查患者和医院特征与IHT对患者结局的相互作用，包括考克斯回归分析、倾向评分分析和效应修正的回归分析。第二阶段将仅关注转移的患者，以便对转移过程因素和患者结局进行深入分析。在这一阶段，我们将首先采用定性方法对一组转移患者和护理人员进行访谈并进行分析，以更详细地了解转移的原因，对护理的期望以及对转移过程的满意度。然后，我们将利用当地医院数据来定量检查转移患者的队列，以识别转移过程的特定性（即，患者到达的时间）和患者特征， 与成本、住院时间和死亡率增加相关。在这项工作的第三阶段，我们将利用前两个阶段获得的信息和现有的知识，安全转移的做法，制定一个标准化的IHT过程，并进行试点研究，使用中断的时间序列方法，以检查这种干预的影响，病人转移的质量。然后，该信息将用于为多中心、整群随机对照试验的开发提供信息，作为未来的R01提交资料。在整个获奖期间，课程，强大的指导，来自多学科咨询委员会的输入，以及机构的支持将提高候选人在流行病学分析和医院为基础的成果研究的方法技能。她还将进一步发展她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。总之，这一多方面的建议将促进穆勒博士的发展，在医院为基础的质量改进和病人安全研究的独立调查员。

 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.