Re-engineering Postnatal Unit Care and the Transition Home to Reduce Perinatal Morbidity and Mortality

重新设计产后病房护理和过渡之家以降低围产期发病率和死亡率

• 批准号: 10264810
• 负责人: Alison M Stuebe
• 金额: $ 59.31万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2023-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10264810
• 关键词: Re; engineering; Postnatal; Unit; Care

ABSTRACT Childbirth is the most common indication for hospitalization the United States; more than 3.8 million women and their infants are discharged from postnatal care each year. Rapid patient turnover, as early as 24-48 hours following vaginal birth and 48-96 hours following cesarean birth, limits time for clinical staff to educate families on priority health issues. Currently, the high volume, relatively short stays, and multiple administrative tasks to be completed prior to discharge, in the absence of effective tools for morbidity detection, increases risk for patient harm. This high throughput system fails to adequately serve infants and mothers: The United States ranks 24 of 35 OECD countries for infant mortality, and we are the only high income country in the world in which maternal mortality rates are rising, with rates 3-4 times greater for non-Hispanic Black women than for non-Hispanic White women. Transdisciplinary collaboration is needed in order to identify underlying contributors to postnatal morbidity and mortality and co-develop more effective, sustainable, and scalable postnatal care. Our long-term objective is to redesign systems of clinical maternity care to better enable new families to thrive. The objective of this proposal is to define postnatal unit problems and create an innovative, individualized delivery system for more effective mother-infant management during postnatal hospitalization and the discharge transition to home. The University of North Carolina at Chapel Hill, in partnership with Systems Engineering at The Ohio State University and the North Carolina State University College of Design, will establish North Carolina Women's Hospital as transdisciplinary Learning Laboratory for mother-infant dyadic management on the postnatal hospital unit and during the transition home. We will evaluate our systems redesign using the primary outcome of a 20% reduction in emergency department visits and readmission from discharge to 90 days postpartum for mothers and infants. To achieve this reduction in postnatal morbidity, we plan to improve patient safety and care value in three intersecting domains: Mother/Baby Recovery, Precision Clinical Care, and Care Transition from Hospital to Home. We will achieve our objectives through the following Specific Aims: Aim 1) Define Priority Areas. Using mixed methods, we will analyze current processes and procedures for maternal-infant dyadic evaluation and management during the postnatal unit stay and discharge transition through the lens of mothers, clinicians, EHR data, and other key stakeholders; Aim 2) Iterative prototyping and evaluation of interventions. Building on identified design seeds, we will alternate between idea generation and evaluation until prototypes emerge that can be implemented and assessed in a low-stakes laboratory setting for refinement and then in the clinical setting; Aim 3) Implementation and dissemination. In this phase, we will use PDSA cycles to fully implement “bundles” of successful innovations on the postnatal unit at NC Women's Hospital and evaluate our primary outcome of acute care utilization within 90 days postpartum. The result of this work will be a human-centered redesign of postnatal care to ensure safer transitions for growing families. The project will enable a stronger start for mothers and their infants, as well as offering a more integrated, value-based model for care that can be shared with other hospitals for widespread implementation.

抽象的 分娩是美国最常见的住院指征；超过 380 万妇女及其婴儿 每年都从产后护理中出院。患者快速周转，早在阴道分娩后 24-48 小时和 48-96 小时 剖腹产后的几个小时限制了临床工作人员对家庭进行优先健康问题教育的时间。目前，高 在缺乏有效的管理措施的情况下，出院前需要完成大量的工作量、相对较短的停留时间以及多项行政任务 发病率检测工具增加了患者受到伤害的风险。这种高吞吐量系统无法充分服务于婴儿和 母亲们：美国的婴儿死亡率在 35 个经合组织国家中排名第 24 位，而且我们是该国唯一的高收入国家 全球孕产妇死亡率不断上升，非西班牙裔黑人女性的死亡率是非西班牙裔黑人女性的 3-4 倍 非西班牙裔白人女性。需要跨学科合作来确定产后的潜在影响因素 发病率和死亡率，并共同开发更有效、可持续和可扩展的产后护理。我们的长期目标是 重新设计临床孕产妇护理系统，以更好地促进新家庭的繁荣发展。该提案的目的是 明确产后单位问题并创建创新的个性化分娩系统，以提高母婴效率 产后住院和出院过渡回家期间的管理。北卡罗来纳大学 在教堂山，与俄亥俄州立大学和北卡罗来纳州立大学的系统工程合作 设计学院将建立北卡罗来纳州妇女医院作为母婴跨学科学习实验室 对产后医院病房和过渡回家期间的二元管理。我们将使用以下方法评估我们的系统重新设计 主要成果是出院后 90 天急诊就诊次数和再次入院次数减少 20% 产后母亲和婴儿。为了降低产后发病率，我们计划提高患者安全和 三个交叉领域的护理价值：母婴康复、精准临床护理和医院护理过渡 到家。我们将通过以下具体目标来实现我们的目标： 目标 1) 确定优先领域。使用混合 方法，我们将分析当前母婴二元评估和管理的流程和程序 通过母亲、临床医生、电子病历数据和其他关键利益相关者的视角，进行产后住院和出院过渡；目的 2) 干预措施的迭代原型设计和评估。在确定的设计种子的基础上，我们将在想法之间交替 生成和评估，直到原型出现，可以在低风险实验室环境中实施和评估 细化，然后在临床环境中；目标 3) 实施和传播。在这个阶段，我们将使用PDSA 周期在北卡罗来纳州妇女医院产后科全面实施“一系列”成功的创新，并评估我们的 产后 90 天内紧急护理利用的主要结果。这项工作的结果将以人为本 重新设计产后护理，以确保成长中的家庭更安全地过渡。该项目将为母亲们提供一个更强有力的开始 及其婴儿，并提供更加综合、基于价值的护理模式，可以与其他医院共享 广泛实施。