Michigan Emergency Department Improvement Collaborative AltERnaTives to admission for Pulmonary Embolism (MEDIC ALERT PE) Study

密歇根急诊科改进合作入院肺栓塞 (MEDIC ALERT PE) 研究

基本信息

批准号：
10584217
负责人：
Geoffrey Douglas Barnes
金额：
$ 70.82万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-01-01 至 2027-12-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10584217
关键词：
Accident and Emergency department Acute Address Adherence Admission activity Adoption Adverse event Ambulatory Care American Anticoagulants Behavioral Sciences Caring Clinical Conflict (Psychology)Data Collection Decision Making Development Diagnosis Disparity Effectiveness Electronics Elements Emergency Department patient Emergency Medicine Ensure Environment Ethnic Origin Evaluation Guidelines Health Care Costs Health Resources Health system Healthcare Hemorrhage Home Hospitalization Hospitals Hybrids Infrastructure Insurance Coverage Intervention Interview Lead Life Link Literature Maintenance Maps Measures Methodology Michigan Morbidity - disease rate Oral Outcome Outpatients Pathway interactions Patient Discharge Patient Preferences Patients Pharmaceutical Preparations Positioning Attribute Process Publishing Pulmonary Embolism Race Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Recommendation Research Resources Retinal blind spot Risk Rural Safety Site Specific qualifier value Testing Theory of Change United States behavior change behavioral economics care delivery clinical decision-making clinical practice design effectiveness study evidence base evidence based guidelines experience follow-up heuristics implementation determinants implementation efforts implementation evaluation implementation framework implementation intervention implementation outcomes implementation protocol implementation science implementation strategy implementation trial improved improved outcome interest mortality multi-component intervention patient oriented patient safety point of care primary outcome program dissemination programs safety outcomes sex suburb success supplemental oxygen theories user centered design

项目摘要

PROJECT SUMMARY Of the 250,000 annual patients in the United States with acute pulmonary embolism (PE), the majority are at low risk for morbidity and mortality. In fact, evidence-based guidelines suggest that up to 50% of patients with an acute PE are at sufficiently low risk for complications that they can be safely managed without hospital admission. Yet fewer than 5% of patients nation-wide are currently discharged for outpatient management. Reliable access to anticoagulant medications and outpatient follow-up are commonly cited barriers to outpatient management. However, prevailing heuristics used by Emergency Medicine clinicians to enable rapid decision-making also firmly link acute PE with hospital admission, and likely makes behavior change for these busy clinicians more challenging. Multiple prior efforts to reduce hospital admission for low-risk patients with acute PE have been limited by single-center designs, inclusion of homogenous and highly-resourced health systems, or have lacked a robust implementation plan underpinning to their design and evaluation. Using the diverse, state-wide Michigan Emergency Department Improvement Collaborative (MEDIC), we will refine, tailor, and evaluate a multi-component intervention suitable for broad dissemination to increase the use of outpatient management of low-risk acute PE for patients presenting to the emergency department. Following an implementation mapping approach built upon published literature and our preliminary findings, our intervention will address key barriers identified by a diverse group of stakeholders by combining traditional implementation science and behavioral economics strategies. Importantly, electronic alerts will be informed by user-centered design approaches to fit within the clinician workflow and decision-making process and “right sized” to appear only for applicable patients. Evaluation will include both quantitative and qualitative elements from the RE-AIM implementation evaluation framework. This multi-component intervention will facilitate a patient-centered approach to clinical decision-making that improves value by reducing unnecessary hospitalization for patients with low-risk PE. Furthermore, by tailoring and evaluating this intervention within a diverse set of hospitals, our multi-component intervention will be well positioned for dissemination nation-wide. Finally, our use of multi-site implementation mapping will provide a blueprint for other multi-site collaboratives interested in improving outcomes for a broad array of clinical conditions through rigorous quality improvement and implementation initiatives.

项目摘要在美国25万名患有急性肺栓塞（PE）的年度患者中，大多数是发病率和死亡率的低风险。实际上，基于证据的指南表明，多达50％的患者急性PE的并发症风险足够低，可以在没有医院的情况下安全地管理它们入场。然而，目前，不到5％的全国患者因门诊管理而出院。可靠获取抗凝药物和门诊随访的机会通常是引用的障碍门诊管理。但是，急诊医学临床医生使用的普遍启发式方法可以快速决策也首先将急性PE与住院的入院联系起来，并可能改变行为忙碌的临床医生更加挑战。为了减少低风险患者的医院入院的多项努力急性PE受到单中心设计的限制，包括同质和资源高度的健康系统，或缺乏针对其设计和评估的强大实施计划。使用多元化的，全州密歇根州急诊室改善合作（MECH），我们将完善，量身定制和评估适合广泛传播的多组分干预措施，以增加使用向急诊科的患者为低风险急性PE的门诊管理。下列的建立在已发表的文献和我们的初步发现的实施映射方法，我们的干预将通过结合传统的利益相关者群体确定的主要障碍实施科学和行为经济学策略。重要的是，电子警报将由以用户为中心的设计方法适合临床工作流程和决策过程，并且“正确大小”仅适用于适用的患者。评估将包括定量和定性元素从Re-AIM实施评估框架。这种多组分干预将有助于以患者为中心的临床决策方法，通过减少不必要的方式提高价值低危PE患者的住院。此外，通过调整和评估此干预措施多样化的医院，我们的多组分干预措施将在全国范围内良好地定位。最后，我们使用多站点实施映射将为其他多站点协作提供蓝图有兴趣通过严格的质量改进来改善各种临床状况的结果和实施计划。