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Effective Primary care practices that Enhance Recovery Trajectories after pneumonia (EXPERT)

增强肺炎后康复轨迹的有效初级保健实践（专家）

基本信息

批准号：
10717618
负责人：
Catherine Lee Hough
金额：
$ 76.16万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-15 至 2028-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10717618
关键词：
Address Advance Care Planning COVID-19 Caring Clinical Trials Critical Care Data Data Set Disease Electronic Health Record Focus Groups Goals Health Health system Hospitalists Hospitalization Hospitals Informatics Intervention Interview Knowledge Link Malignant Neoplasms Measures Medical Sociology Medicine Methods Myocardial Infarction Outcome Palliative Care Patient-Focused Outcomes Patients Pharmaceutical Preparations Physical therapy Pneumonia Primary Care Process Randomized Recovery Research Respiratory Failure Sepsis Site Stroke Structure Survivors System Testing United States Work clinical epidemiology design experience follow-up hospital readmission implementation determinants improved improved outcome innovation insight intervention refinement long term recovery medical specialties novel pilot trial post-COVID-19 pragmatic randomized trial primary care clinician primary care practice primary care services primary care team process improvement prototype public health priorities trial design user centered design

项目摘要

Even before COVID-19, pneumonia with respiratory failure was a very common cause of hospitalization. Unfortunately, many patients who survive pneumonia have persistent health problems for months or years afterwards. The objective of this Effective Primary Care Practices that Enhance Recovery Trajectories after Pneumonia (EXPERT) study is to use appreciative inquiry to help primary care clinicians take better care of pneumonia patients in the 6 months after hospital–by taking a strengths-based approach for transformational change to design and test a new systems-level intervention. We will use a multi-methods approach wherein quantitative analysis of primary care actions and qualitative interviews with expert primary care clinicians and patients are used to refine an innovative intervention in a participatory prototyping pilot trial. The pilot trial targets mechanistic process outcomes linked to increased hospital-free days for pneumonia survivors. Our team from primary care, hospitalist medicine, critical care, palliative care, sepsis, informatics, clinical epidemiology, medical sociology, and clinical trials, will: Aim 1: Quantitatively analyze granular EHR data to identify and refine candidate components for a primary care intervention to improve post-pneumonia care. We will leverage large, feature-rich datasets from our team’s 3 diverse health systems to identify specific orders, referrals, and billing services by primary care clinicians that are substantially more frequent in the 6 months after pneumonia than before and temporally associated with reduced subsequent hospitalization. Aim 2: Qualitatively analyze the experiential insights of primary care clinicians and pneumonia survivors to identify and refine candidate components and identify enablers and barriers for the post-pneumonia intervention. We will conduct semi-structured interviews and focus groups with PCCs and pneumonia survivors across 4 states to evaluate key actions and implementation factors for successful post-pneumonia recovery. Aim 3. Refine and pilot a novel multicomponent primary care intervention to improve delivery of post-pneumonia care that will lead to improved health outcomes for pneumonia survivors. We will use a novel stakeholder-engaged strategy of participatory prototyping to iteratively optimize the intervention and evaluate its effects on target mechanistic outcomes in an eight-site cluster randomized pilot trial design. EXPERT’s research addresses a fundamental knowledge gap in post-pneumonia care, a public health priority. We propose to use appreciative inquiry to help primary care do what primary care does well, and to optimize an intervention that makes it easier for them to do so.

即使在COVID-19之前，肺炎伴呼吸衰竭也是非常常见的住院原因。不幸的是，许多肺炎患者幸存下来后，健康问题持续数月或数年事后这一有效的初级保健实践，提高恢复轨迹的目标肺炎后（专家）研究是使用赞赏性询问，以帮助初级保健临床医生采取更好的护理的肺炎患者在住院后6个月内-通过采取基于力量的方法，转型变革，以设计和测试新的系统级干预措施。我们将使用多方法的方法，其中定量分析初级保健行动和定性与专家初级保健临床医生和患者的访谈被用来完善一个创新的干预措施，参与式原型试验。试点试验的目标是机械过程的结果，肺炎幸存者的无住院日。我们的团队来自初级保健，住院医学，重症监护，姑息治疗、败血症、信息学、临床流行病学、医学社会学和临床试验将：目标1：量化分析粒度EHR数据，以识别和细化候选组件，初级保健干预，以改善肺炎后护理。我们将利用功能丰富的大型数据集从我们的团队的3个不同的健康系统，以确定具体的订单，转介，并按主要计费服务护理临床医生在肺炎后6个月内比肺炎前更频繁，与后续住院减少有关。目标2：定性分析经验见解初级保健临床医生和肺炎幸存者，以确定和完善候选成分，确定肺炎后干预的推动因素和障碍。我们将进行半结构化与4个州的PCC和肺炎幸存者进行访谈和焦点小组，以评估关键行动，肺炎后成功康复的实施因素。目标3.完善和试点一本小说多组分初级保健干预，以改善肺炎后护理的提供，改善肺炎幸存者的健康状况。我们将使用一种新颖的企业主参与战略，参与式原型设计，以迭代优化干预措施，并评估其对目标机制的影响结果在一个八个地点的集群随机试点试验设计。专家的研究解决了肺炎后护理的基本知识差距，这是公共卫生的优先事项。我们建议使用赞赏性询问，以帮助初级保健做什么初级保健做得很好，并优化一种能让他们更容易这么做的干预。