The Virtual Mentored Implementation to Reduce REVISITS (Reducing Respiratory Emergent Visits using Implementation Science Interventions Tailored to Setting) Study

项目总结 慢性阻塞性肺疾病(COPD)影响着1600万美国成年人，其中许多人经历了 急诊科和医院COPD因护理过渡而初次住院后的复诊率 失败。这些频繁的COPD恶化导致更快的肺功能下降和更早的死亡。 此外，因病情恶化而住院极大地贡献了每年用于慢性阻塞性肺病治疗的约500亿美元 美国。因此，慢性阻塞性肺病的复诊现在是一种公共健康危机。改善COPD的护理和治疗是可行的 减少急性护理复诊，已发表的护理过渡干预成功的证据表明。我们的 团队领导了确定有效的护理过渡干预措施的努力，并成功地试行了多层次 慢性阻塞性肺疾病护理过渡计划。有效的护理过渡干预措施包括药物调节、自我 管理教育和出院后沟通。然而，为了实现广泛的采用，我们 必须根据医院的资源和患者的护理需求确定最佳的干预提供方法。为 例如，虚拟支持的干预措施通常对资源更友好，虽然关于 个别虚拟干预措施已经存在，多层次虚拟方案还没有被研究过。 个人程序。此外，支持提供循证服务的可行执行办法 大范围传播和可持续发展需要护理过渡方案。我们团队发现， 有指导的实施模式对于在全美实施多层次、以医院为基础的项目是有效的 卫生系统。这种方法传统上依赖于面对面的现场访问。使用虚拟站点访问可以 极大地增加了这一模型的覆盖范围，但尚未被研究。总而言之，对于成功的、广泛的 采用，不同的美国医院需要能够获得可行的、多层次的护理过渡计划和 与现场具体护理需求和资源相一致的有效实施方法，但目前 最优的方法是未知的。因此，在这项建议中，我们将比较虚拟与在以下方面的有效性- 在现实世界环境中通过同时研究是否 虚拟或面对面指导的实施扩大了项目的覆盖范围。我们将与医院合作 医学再工程网络召开，以快速发现和传播，以确定和登记地点。 在所有站点使用以下综合框架进行实施前环境评估之后 实施研究，我们将进行第二类混合有效性-实施研究，以确定 减少30天慢性阻塞性肺疾病复诊的方案的有效性和指导实施的有效性 计划渗透率。最后，我们将研究项目实施后两年的持续成果。 这项研究的数据将为大规模COPD护理过渡计划的最佳实施提供信息。此外， 从这项研究中获得的经验教训可以为其他以医院为基础的项目的实施提供参考。

PROJECT SUMMARY Chronic Obstructive Pulmonary Disease (COPD) affects 16 million US adults, many of whom experience high rates of emergency department and hospital COPD revisits after initial hospitalizations due to care transition failures. These frequent COPD exacerbations lead to more rapid lung function decline and earlier mortality. Further, hospitalizations for exacerbations highly contribute to the ~$50 billion spent annually for COPD care in the US. Therefore, COPD revisits are now a public health crisis. It is feasible to improve COPD care and decrease acute care revisits, as shown by published evidence of successful care transition interventions. Our team has led efforts to identify effective care transition interventions and has successfully piloted a multi-level COPD care transition program. Effective care transition interventions include medication reconciliation, self- management education, and post-discharge communication. However, for wide-spread adoption to occur, we must identify optimal intervention delivery methods based on hospitals' resources and patient care needs. For instance, virtually-supported interventions are often more resource-friendly, and while effectiveness data on individual virtual interventions exists, multi-level virtual programs have not yet been studied compared to in- person programs. In addition, feasible implementation approaches to support the delivery of evidence-based care transition programs are needed for wide-scaled dissemination and sustainability. Our team has found that a mentored implementation model is effective for implementing multi-level, hospital-based programs across US health systems. This approach traditionally relies on in-person site visits. The use of virtual site visits could dramatically increase this model's reach, but has not yet been studied. In summary, for successful, wide-scale adoption, diverse US hospitals need to have access to feasible, multi-level care transition programs and effective implementation approaches that are aligned with site-specific care needs and resources, but currently the optimal approach is unknown. Thus, in this proposal, we will compare the effectiveness of virtual vs. in- person multi-level COPD care transition programs in real-world settings by concurrently studying whether virtual or in-person mentored implementation increases programs' reach. We will collaborate with the Hospital Medicine Reengineering Network convened for rapid discovery and dissemination to identify and enroll sites. After conducting pre-implementation contextual assessments at all sites using the Consolidated Framework for Implementation Research, we will conduct a Hybrid Type II Effectiveness-Implementation study to determine effectiveness of the programs to reduce 30-day COPD revisits and of the mentored implementation to increase program penetration. Finally, we will study programs' sustained outcomes for two years post-implementation. Data from this study will inform the optimal implementation of COPD care transition programs at scale. Further, lessons gleaned from this study can inform implementation approaches for other hospital-based programs.