Developing Capacity to Improve Care Transitions for Injury Patients in Tanzania

发展能力以改善坦桑尼亚受伤患者的护理过渡

• 批准号: 10018233
• 负责人: Janet Alexandria Prvu Bettger
• 金额: $ 12.51万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-02-01 至 2021-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10018233
• 关键词: Acute; Address; Adult; Age-Years; Alcohol or Other Drugs use; Area; Caring; Cause of Death; Cessation of life; Chronic Disease; Clinical; Clinical Trials; Communities; Comorbidity; Complex; Comprehensive Health Care; Country; Data; Family; Family member; Future; General Population; Goals; HIV; HIV diagnosis; Health; Health system; Hospitalization; Hospitals; Human immunodeficiency virus test; Income; Individual; Injury; International; Intervention; Interview; Length of Stay; Low income; Medical; Medical center; Mental Health; Modeling; Morbidity - disease rate; Newly Diagnosed; Outcome; Pain; Pathway interactions; Patient-Focused Outcomes; Patients; Persistent pain; Physically Handicapped; Population; Quality of life; Registries; Research; Research Personnel; Resources; Risk; Risk Factors; Services; Substance abuse problem; Tanzania; Testing; Transitional Care Planning; Trauma; Trauma patient; base; data registry; disability; disability-adjusted life years; evidence base; follow-up; global health; health management; high risk; implementation science; improved; injured; international center; low and middle-income countries; low income country; mortality; multidisciplinary; posthospitalization care; social; standard of care; years of life lost

Abstract: Injuries are a global health crisis annually causing 6 million deaths and over 650 million people worldwide living with disabilities. Injuries have a particular impact on people between 5 and 44 years of age and are the leading cause of disability adjusted life years lost in low and middle income settings. Strategies to assist newly injury patients in their transition from the acute setting to the community reduce mortality and morbidity in high income settings. Comprehensive and evidence based transition of care strategies are not currently used in most low income settings due to a myriad of limitations. Over 2000 patients annually are seen at Kilimanjaro Christian Medical Center (KCMC) for acute injuries of which 59% are admitted for an average length of stay of 10 days. Upon discharge from an acute injury hospitalization, adult injury patients have a complex array of complications across the ‘five domains’ of healthcare management which include function, mental health, substance abuse, pain, and comorbidities (which includes HIV). In high income countries, up to 79% of injury patients suffer complications in one of these domains post hospitalization. While data is lacking, preliminary data in the region suggests that HIV is more common in the injury population than the general public and could worsen outcomes. Managing the health and social needs of an adult injury patient post hospitalization requires a multidisciplinary team to address each of these domains. The goal of this important project is to build capacity in order to improve the health and quality of life for injury patients, particularly focusing on our five health domains, by (1) understanding and addressing the care transition needs (including any HIV related needs), and (2) creating a resource-appropriate comprehensive care transitions strategy. Ultimately, we will build the research capacity to qualitatively develop and feasibly test this intervention. By the conclusion of this project, we will have created a team of local and international health system clinical researchers, a high quality injury registry, a descriptive understanding of the rates of known and newly diagnosed HIV as well as the complications HIV patients suffer during acute injuries, and an piloted evidence-based and resource-appropriate care transition strategy feasible for implementation in a fully powered clinical trial. There is tremendous potential for this research to strengthen care pathways at KCMC for injury patients with and without HIV, build capacity for pragmatic stakeholder-engaged clinical trials, and improve patient and family outcomes.

抽象的： 伤害是一场全球健康危机，每年造成 600 万人死亡，全球超过 6.5 亿人生活在其中 患有残疾。伤害对 5 岁至 44 岁之间的人群影响尤为严重，是造成伤害的主要原因 低收入和中等收入环境中残疾原因调整后损失的生命年。协助新伤的策略 患者从急性环境过渡到社区可降低高死亡率和发病率 收入设置。目前尚未使用全面且基于证据的护理策略转变 由于无数的限制，大多数低收入环境。 乞力马扎罗基督教医疗中心 (KCMC) 每年收治超过 2000 名急性损伤患者 其中 59% 的患者平均停留时间为 10 天。急性损伤出院后 住院期间，成人损伤患者会出现一系列复杂的并发症，涉及“五个领域” 医疗保健管理，包括功能、心理健康、药物滥用、疼痛和合并症 （其中包括艾滋病毒）。在高收入国家，高达 79% 的损伤患者患有其中一种并发症 住院后的域。虽然缺乏数据，但该地区的初步数据表明，艾滋病毒比 在受伤人群中比普通公众更常见，并且可能会恶化结果。管理健康和 成年受伤患者住院后的社会需求需要多学科团队来满足每个 这些域。 这个重要项目的目标是建设能力，以改善受伤后的健康和生活质量 患者，特别关注我们的五个健康领域，通过 (1) 理解和解决护理问题 过渡需求（包括任何与艾滋病毒相关的需求），以及 (2) 创建资源适当的综合性 护理过渡策略。最终，我们将建设研究能力，以实现高质量发展并切实可行 测试这种干预。到该项目结束时，我们将创建一支由本地和国际人员组成的团队 卫生系统临床研究人员、高质量的伤害登记、对受伤率的描述性了解 已知和新诊断的艾滋病毒以及艾滋病毒患者在急性损伤期间遭受的并发症，以及 试点的基于证据和资源适当的护理过渡战略是可行的，可以在全面 动力临床试验。这项研究对于加强 KCMC 的护理途径具有巨大的潜力 感染和未感染艾滋病毒的伤害患者，建立务实的利益相关者参与临床试验的能力，以及 改善患者和家庭的治疗结果。

项目成果

Barriers to accessing follow up care in post-hospitalized trauma patients in Moshi, Tanzania: A mixed methods study.

• DOI: 10.1371/journal.pgph.0000277
• 发表时间: 2022
• 期刊: PLOS global public health
• 作者: Joiner, Anjni Patel;Tupetz, Anna;Peter, Timothy Antipas;Raymond, Julius;Macha, Victoria Gerald;Vissoci, Joao Ricardo Nickenig;Staton, Catherine
• 通讯作者: Staton, Catherine

A systematic review and cross-sectional survey of rehabilitation resources for injury patients in the Kilimanjaro Region of Tanzania.

对坦桑尼亚乞力马扎罗地区受伤患者康复资源的系统回顾和横断面调查。

• DOI: 10.1080/09638288.2023.2179674
• 发表时间: 2024
• 期刊: Disability and rehabilitation
• 影响因子: 2.2
• 作者: Zimmerman,Armand;Minnig,MaryCatherine;Meela,Joseph;Tupetz,Anna;Bettger,JanetPrvu;Vissoci,JoaoRicardoNickenig;Staton,Catherine
• 通讯作者: Staton,Catherine

"I Don't Do Anything; I'm Just Being Taken Care Of": Experiences of Patients and Their Caregivers Transitioning Back into the Community Following Traumatic Injury in Northern Tanzania.

• DOI: 10.3390/traumacare2020028
• 发表时间: 2022-06
• 期刊: Trauma care (Basel, Switzerland)
• 作者: Tupetz A;Barcenas LK;Isaacson JE;Nickenig Vissoci JR;Gerald V;Kingazi JR;Mushi I;Peter TA;Staton CA;Mmbaga BT;Bettger JP
• 通讯作者: Bettger JP

Injury characteristics and their association with clinical complications among emergency care patients in Tanzania.

• DOI: 10.1016/j.afjem.2022.08.001
• 发表时间: 2022-12
• 期刊: African journal of emergency medicine : Revue africaine de la medecine d'urgence