Improving Safety of Transitions to Skilled Nursing Care Using Video-conferencing

使用视频会议提高向熟练护理过渡的安全性

• 批准号: 9789893
• 负责人: LEWIS LIPSITZ
• 金额: $ 49.8万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9789893
• 关键词: Improving; Safety; Transitions; Skilled; Nursing

Abstract: Discharge from hospitals to skilled nursing facilities (SNFs) represents a challenging and potentially dangerous care transition due to gaps in communication and changes in providers, different medication formularies, and misaligned treatment plans. Due to their high burden of co-morbidities, multiple medications, and impaired adaptive mechanisms, older adults are particularly vulnerable to adverse outcomes. In response to this health care challenge, hospitalists and geriatricians at Beth Israel Deaconess Medical Center (BIDMC) developed a novel video-communication program called ECHO-CT (Extension for Community Healthcare Outcomes-Care Transitions). ECHO-CT uses a multidisciplinary case-based model to connect hospital-based physicians, social workers and pharmacists with post-acute care providers, to enhance communication and improve care transitions of elderly patients discharged to SNFs. Our pilot outcome data show that compared to matched control facilities undergoing usual care, those participating in ECHO-CT had significantly lower 30-day readmission rates (Odds Ratio 0.57; 95% CI 0.34 – 0.96; p=0.0353), lower 30-day total healthcare costs ($2,602.19 lower; 95% CI -$4,133.90- -$1,070.48; p=0.0009), and shorter average lengths of stay at the SNF (- 5.52 days; 95% CI -9.61- -1.43; p=0.0081). However, we do not know whether these results can be replicated when compared to a national sample, whether patient safety is improved, nor whether the ECHO-CT program can be exported to other hospitals and post-acute care facilities. Therefore, in this proposal we aim to determine the effect of a weekly video-technology-enabled communication between acute hospital-based and SNF-based providers on improving care transitions, reducing adverse outcomes, preventing rehospitalizations, and reducing total health care costs for vulnerable elderly Medicare beneficiaries. Our specific aims are to: 1) replicate the ECHO-CT program on a larger scale in a tertiary and community-based hospital network of SNFs; 2) test the hypothesis that SNFs participating in the ECHO-CT intervention will demonstrate: a) fewer 30-day hospital readmissions, b) lower 30-day health care costs, c) shorter lengths of stay in the SNF, and d) fewer adverse safety outcomes compared to Medicare patients in a large group of similar New England SNFs; and 3) assess operational challenges and stakeholder satisfaction with the ECHO-CT program and use this information to develop the protocols and tools necessary for the future dissemination of ECHO-CT to other medical centers. The expertise of our team at Harvard Medical School and availability of Medicare Claims and Minimum Data Set data from Brown University will help assure the project’s success.

抽象的： 从医院到熟练护士设施（SNF）的出院代表了一个挑战和潜在的危险 由于沟通差距和提供者的变化，不同的药物配方和 未对准治疗计划。由于它们的合并症负担很高，多种药物和受损 自适应机制，老年人特别容易受到不利结果的影响。回应这种健康 贝丝以色列执事医疗中心（BIDMC）的护理挑战，医院主义者和老年医生开发了 新颖的视频通信计划，称为Echo-CT（社区医疗保健成果的扩展 过渡）。 Echo-CT使用基于多学科的案例模型来连接基于医院的医生，社会 拥有急性后护理提供者的工人和药剂师，以增强沟通并改善护理 古老的患者过渡到SNF。我们的飞行员结果数据显示了与匹配相比 经过常规护理的控制设施，参与Echo-CT的人的30天明显降低 再入院率（优势比0.57; 95％CI 0.34 - 0.96; p = 0.0353），较低的30天总医疗保健费用 （$ 2,602.19较低； 95％CI- $ 4,133.90-- $ 1,070.48; p = 0.0009），在SNF的平均停留时间较短（ - 5.52天； 95％CI -9.61- -1.43; p = 0.0081）。但是，我们不知道这些结果是否可以复制 与国家样本相比，无论患者安全是否得到改善，还是Echo-CT计划是否 可以出口到其他医院和急性后护理机构。因此，在此提案中，我们的目标是 确定急性医院和 基于SNF的提供者改善了护理过渡，减少不良结果，防止重新住院化， 并降低弱势医疗保险受益人的总医疗保健成本。我们的具体目的是：1） 在SNF的第三纪和社区医院网络中，以更大的规模复制Echo-CT计划； 2）检验参加ECT-CT干预的SNF的假设将证明：a）较少的30天 医院再入院，b）较低的30天医疗保健费用，c）SNF的停留时间较短，d）更少 与大量新英格兰SNF中的Medicare患者相比，不利的安全结果； 3） 评估运营挑战和利益相关者对Echo-CT计划的满意 信息以开发未来将Echo-CT传播到其他的协议和工具 医疗中心。我们在哈佛医学院团队的专业知识以及Medicare索赔的可用性和 布朗大学的最低数据集数据将有助于确保该项目的成功。