Identification and Prevention of Potentially Inappropriate Inter-hospital Transfers

识别和预防潜在的不当医院间转移

• 批准号: 10707162
• 负责人: Stephanie Mueller
• 金额: $ 40万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 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 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10707162
• 关键词: Identification; Prevention; Potentially; Inappropriate; Inter

ABSTRACT Despite assumptions that inter-hospital transfer (IHT, the transfer of patients between acute care hospitals) is done to provide patients with necessary specialized care, IHT also exposes vulnerable hospitalized patients to the risks of discontinuity of care. Our recent research suggests that a subset of transferred patients may experience harm during IHT without clear benefit; however, we currently lack data on how to identify in which patients harm outweighs benefit of transfer, i.e., experience inappropriate IHT. The long-term objective of this research is to rigorously define and evaluate the incidence and patient safety impact of potentially inappropriate IHT among hospitalized medical patients, identify patients at risk for inappropriate transfer, and develop an intervention toolkit to reduce potentially inappropriate IHT. To achieve this, we will work with diverse stakeholders involved in IHT, including patients/families, accepting and admitting clinicians, transferring clinicians, and hospital leadership to define potentially inappropriate IHT. We will then determine the incidence and patient safety impact of potentially inappropriate IHT via standardized adjudication of 1800 hospitalized medical patients from 18 US hospitals that participate in a national research collaborative (HOMERuN) and contribute data to a benchmarking and purchasing organization (Vizient). Adjudication tools will be based on those used in similar prior research and will be informed by stakeholder definitions of potentially inappropriate IHT. We will incorporate rigorous adjudicator training and continuous review to ensure reliability across sites, adjudicators, and time. We will then use standard modelling techniques to retrospectively characterize a population(s) of potentially inappropriate patient transfers based on several patient, transfer process, and system-level factors. This will be followed by advanced machine-learning methods to prospectively identify patients at risk for potentially inappropriate IHT and validation of the model's performance. Finally, we will utilize key results from the above analyses and stakeholder input to create a prototype intervention, refine the prototype based on feedback from participating sites using a mixed methods approach, and develop a toolkit of best practices to prevent potentially inappropriate IHT (e.g., by replacing it with a safer alternative) for future dissemination. This research will establish a foundation from which healthcare systems can achieve excellence in providing patients with the right care, in the right setting.

摘要 尽管假设医院间转移（IHT，即急性护理之间的患者转移） 医院）为患者提供必要的专业护理，IHT也暴露了脆弱的 住院患者面临护理中断的风险。我们最近的研究表明， 转移的患者在IHT期间可能会受到伤害，但没有明显的益处;然而，我们目前缺乏以下数据： 如何确定哪些患者的伤害超过了转移的受益，即，经历不适当的IHT。 这项研究的长期目标是严格定义和评估发病率和患者 住院医疗患者中潜在不适当IHT的安全性影响，确定存在以下风险的患者 不适当的转让，并制定干预工具包，以减少潜在的不适当的国际卫生治疗。实现 为此，我们将与参与IHT的不同利益相关者合作，包括患者/家属，接受和承认 临床医生、转科临床医生和医院领导，以确定潜在的不适当的IHT。然后我们将 通过标准化裁定确定潜在不适当IHT的发生率和患者安全性影响 来自18家美国医院的1800名住院患者参加了一项国家研究合作， （HOMERuN）并向基准和采购组织（Vizient）提供数据。裁定工具 将以类似的先前研究中使用的数据为基础，并将根据利益相关者对 可能不合适的IHT。我们会对审裁人员进行严格的培训，并不断进行检讨，以确保 跨研究中心、裁定者和时间的可靠性。然后，我们将使用标准建模技术， 回顾性地描述基于几个因素的潜在不适当患者转移人群 患者、转移过程和系统级因素。这将是先进的机器学习 方法，以前瞻性地确定患者的风险，潜在的不适当的IHT和验证模型的 性能最后，我们将利用上述分析的主要结果和利益相关者的意见， 原型干预，使用混合方法根据参与研究中心的反馈完善原型 方法，并开发一个最佳做法工具包，以防止可能不适当的国际人道主义疗法（例如，来替代hcfc 具有更安全的替代物）以供将来传播。这项研究将奠定一个基础， 医疗保健系统可以在正确的环境中为患者提供正确的护理方面取得卓越成就。