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

甚至在新冠肺炎之前，肺炎合并呼吸衰竭就是住院的一个非常常见的原因。 不幸的是，许多在肺炎中幸存下来的患者会持续数月或数年的健康问题。 之后。这种有效的初级保健做法的目标是加强康复轨迹 肺炎后(专家)研究是使用鉴赏性询问来帮助初级保健临床医生更好地护理 肺炎患者在出院后6个月内-采取以实力为基础的方法 设计和测试一种新的系统级干预的变革性变化。 我们将使用多方法方法，其中对初级保健行动和定性 对初级保健专家、临床医生和患者的访谈被用于改进创新的干预措施 参与式原型中试。试点试验的目标是将机械化过程结果与 肺炎幸存者无住院日。我们的团队从初级保健、住院医疗、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：对细粒度的EHR数据进行量化分析，以确定和提炼 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 从我们团队的3个不同的医疗系统中确定特定的订单、转诊和计费服务 在肺炎后6个月内护理临床医生的频率明显高于肺炎前和临时性 与减少随后的住院有关。目标2：定性分析经验式洞察力 初级保健临床医生和肺炎幸存者，以确定和改进候选组件 确定肺炎后干预的促进因素和障碍。我们将进行半结构化 与4个州的初级保健医生和肺炎幸存者进行访谈和焦点小组，以评估关键行动和 肺炎后康复成功的实施因素。目标3：提炼并试行一部小说 多成分初级保健干预，以改善肺炎后护理的提供，这将导致 改善肺炎幸存者的健康状况。我们将使用一种新的利益相关者参与战略， 参与式原型迭代优化干预及其对靶机制影响的研究 八个地点的群组随机试点试验设计的结果。 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。 我们建议使用鉴赏性调查来帮助初级保健做好初级保健的工作，并优化 一种让他们更容易做到这一点的干预。

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.