Improving patient prioritization during hospital-homecare transition: A mixed methods study of a clinical decision support tool

改善医院-家庭护理过渡期间患者的优先顺序：临床决策支持工具的混合方法研究

• 批准号: 10242917
• 负责人: Maxim Topaz
• 金额: $ 62.61万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-25 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10242917
• 关键词: Academic Medical Centers; Accident and Emergency department; Acute; Address; Admission activity; Adoption; Caregivers; Caring; Community Hospitals; Complex; Control Groups; Data; Decision Making; Discipline; Discipline of Nursing; Early Intervention; Effectiveness; Evaluation; Funding Opportunities; Health; Healthcare; Home Nursing Care; Home environment; Hospitals; Hour; Incidence; Intervention; Intervention Studies; Interview; Length of Stay; Logistic Regressions; Maintenance; Medicare; Methodology; Methods; National Institute of Nursing Research; Nurses; Outcome; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Phase; Pilot Projects; Population; Process; Public Health Informatics; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Registered nurse; Research; Research Personnel; Resources; Risk; Self Care; Services; Standardization; Structure; Survival Analysis; Technology; Testing; Time; United States; Visit; Visiting Nurse; Work; base; clinical decision support; effectiveness evaluation; effectiveness study; effectiveness trial; efficacy study; evidence base; health information technology; high risk; hospital readmission; implementation tool; improved; innovation; interest; patient home care; post intervention; prevent; simulation; support tools; tool

Improving patient prioritization during hospital-homecare transition: A mixed methods study of a clinical decision support tool. Each year, more than 5 million patients are admitted to the approximately 12,000 homecare agencies across the United States. About 20% of homecare patients are rehospitalized during the homecare episode, with as many as 68% of these rehospitalizations occurring within the first two weeks of services. A significant portion of these rehospitalizations may be prevented by timely and appropriately targeted allocation of homecare services. The first homecare nursing visit is one of the most critical steps of the homecare episode. This visit includes an examination of the home environment, a discussion regarding whether a caregiver is present, an assessment of the patient's capacity for self-care, and medication reconciliation. A unique care plan is created based on this evaluation of the patient’s needs. Hence, appropriate timing of the first visit is crucial, especially for patients with urgent healthcare needs. However, nurses often have very limited and inaccurate information about incoming patients and patient priority decisions vary significantly between nurses. We developed an innovative decision support tool called “Priority for the First Nursing Visit Tool” (PREVENT) to assist nurses in prioritizing patients in need of immediate first homecare nursing visits. In a recent efficacy pilot study of PREVENT, high-risk patients received their first homecare nursing visit a half day sooner as compared to the control group, and 60-day rehospitalizations decreased by almost half as compared to the control group. The proposed study assembles a strong interdisciplinary team of experts in health informatics, nursing, homecare, and sociotechnical disciplines to evaluate PREVENT in a pre-post intervention effectiveness study. Specifically, the study aims are: Aim 1) Evaluate the effectiveness of the PREVENT tool on process and patient outcomes. Using survival analysis and logistic regression with propensity score matching we will test the following hypotheses: Compared to not using the tool in the pre-intervention phase, when homecare clinicians use the PREVENT tool, high risk patients in the intervention phase will: a) receive more timely first homecare visits and b) have decreased incidence of rehospitalization and have decreased emergency department (ED) use within 60 days. Aim 2) Explore PREVENT’s reach and adoption by the homecare admission staff and describe the tool’s implementation during homecare admission. Aim 2 will be assessed using mixed methods including homecare admission staff interviews, think-aloud simulations, and analysis of staffing and other relevant data. This innovative study addresses several National Institute of Nursing Research strategic priorities, such as promoting innovation and using technology to improve health. Mixed methods will enable us to gain in-depth understanding of the complex socio-technological aspects of hospital-homecare transition.

在医院-家庭护理过渡期间改善患者优先顺序：一项混合方法研究， 临床决策支持工具。 每年，大约12，000家家庭护理机构接纳了500多万名患者 遍布美国各地。大约20%的家庭护理患者在家庭护理期间再次住院， 其中多达68%的再住院发生在服务的前两周内。显著 这些再住院的一部分可以通过及时和适当地有针对性地分配 家庭护理服务。第一次家庭护理访视是家庭护理事件中最关键的步骤之一。 这次访问包括家庭环境的检查，关于照顾者是否 目前，评估患者的自我护理能力和药物调节。独特的关怀 根据对患者需求的评估制定计划。因此，第一次访问的适当时间是 这是非常重要的，特别是对于有紧急医疗需求的患者。然而，护士往往有非常有限的， 关于入院病人和病人优先权决定的不准确信息在护士之间有很大差异。 我们开发了一个创新的决策支持工具，称为“优先为第一护理访问工具” （预防），以协助护士优先病人需要立即第一次家庭护理访视。中 最近的一项PREVENT疗效试点研究，高危患者接受了为期半天的首次家庭护理访视 与对照组相比，60天再住院率几乎减少了一半， 对照组。这项拟议的研究汇集了一个强大的跨学科的健康专家团队 信息学、护理学、家庭护理学和社会技术学科，以评估预防干预前后的情况 有效性研究。具体而言，本研究的目的是：目的1）评价预防的有效性 过程和患者结果的工具。使用生存分析和Logistic回归与倾向评分 匹配我们将测试以下假设：与在干预前阶段不使用工具相比， 当家庭护理临床医生使用预防工具时，处于干预阶段的高风险患者将：a）接受 更及时的首次家庭护理访视和B）降低了再住院的发生率， 急诊科（艾德）60天内使用。目标2）探索预防的范围和采用 家庭护理入院人员，并描述该工具在家庭护理入院期间的实施情况。目的2 将使用混合方法进行评估，包括家庭护理入学人员访谈，有声思维模拟， 分析人员配置和其他相关数据。 这项创新的研究解决了几个国家护理研究所的战略重点，如 促进创新和利用技术改善健康。混合方法将使我们能够深入了解 了解医院-家庭护理过渡的复杂社会技术方面。