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.

摘要： 从医院出院到熟练护理机构(SNF)是一种具有挑战性和潜在危险的 由于沟通的差距和提供者的变化、不同的药物处方以及 错位的治疗计划。由于他们的高负担的共病，多种药物，和损害 在适应机制方面，老年人特别容易受到不利后果的影响。为了应对这种健康 护理挑战，贝丝以色列女执事医疗中心(BIDMC)的住院医生和老年医生开发了一种 名为ECHO-CT(社区医疗保健结果扩展)的新型视频通信计划 过渡)。ECHO-CT使用基于病例的多学科模式将医院医生、社会 工作人员和药剂师与急性后护理提供者合作，以加强沟通和改善护理 老年患者出院至SNF的过渡期。我们的试点结果数据显示，与匹配的 接受常规护理的对照设施，那些参加ECHO-CT的人30天内显著减少 再住院率(优势比0.57；95%可信区间0.34-0.96；p=0.0353)，较低的30天总医疗费用 (低2,602.19美元；95%CI-4,133.90美元--1,070.48美元；p=0.0009)，以及在三菱国民警卫队的平均停留时间缩短(- 5.52d；95%CI-9.61-1.43；p=0.0081)。然而，我们不知道这些结果是否可以复制 与全国样本相比，患者的安全性是否得到改善，ECHO-CT计划是否 可出口到其他医院和急诊后护理机构。因此，在这项提案中，我们的目标是 确定以急诊医院为基础的和以视频技术为基础的每周沟通的效果 基于SNF的提供者关于改善护理过渡、减少不良后果、防止再次住院、 以及降低弱势老年医疗保险受益人的总医疗费用。我们的具体目标是：1) 在以社区为基础的三级医院网络中更大规模地推广ECHO-CT计划； 2)测试参与ECHO-CT干预的SNF将证明：a)少于30天的假设 再次住院，b)更低的30天医疗保健费用，c)更短的住院时间，以及d)更少 在一大群相似的新英格兰SNF中，与医疗保险患者的不良安全结果进行比较；3) 评估ECHO-CT计划的运营挑战和利益相关者满意度，并使用 为今后向其他国家传播ECHO-CT制定必要的协议和工具提供信息 医疗中心。我们在哈佛医学院的团队的专业知识以及联邦医疗保险索赔和 来自布朗大学的最低数据集数据将有助于确保该项目的成功。