A quality and cost analysis of interprofessional team continuity in ICUs

ICU 跨专业团队连续性的质量和成本分析

• 批准号: 10624285
• 负责人: Olga Yakusheva
• 金额: $ 39.86万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10624285
• 关键词: quality; cost; analysis; interprofessional; team

PROJECT ABSTRACT Critical care is the most complex, resource-intensive and costly care setting contributing over $130 billion to national health expenditures annually. Approximately 4 million patients are admitted to intensive care units (ICUs) each year with average mortality rate ranging from 8-19. Recently COVID-19 has highlighted that staffing interprofessional teams in ICUs is quite challenging. One feature of healthcare staffing that has received much attention in settings outside of the ICU is continuity of care – whereby a patient is cared for by a small team of identified professionals over time – has been long recognized as an essential attribute of high- quality, patient-centered care. In primary care, greater continuity of patient care is associated with fewer emergency department visits and hospitalizations, lower healthcare costs, and higher patient satisfaction. Continuity-based acute care staffing models also exist, but are rarely adopted and sustained in practice, particularly in ICUs where continuity-based assignments can be challenging to operationalize. Importantly, although critical care is delivered by interprofessional teams of physicians, nurses, and respiratory therapists, continuity of interprofessional ICU teams has never been conceptualized or measured before. Without this knowledge, it is difficult to know whether hospitals and administrators should prioritize continuity of ICU care, which could be a missed opportunity to improve quality of patient care and outcomes in this critically ill, costly patient population. The overall goal of our study is to examine the effect of continuity of ICU interprofessional teams on patient outcomes and organizational economic outcomes, in order to develop an interprofessional assignment decision-support tool that optimizes the continuity of interprofessional ICU team care. We propose to examine the quality and costs of an interprofessional team continuity staffing approach in ICUs to guide future interventions in 13 ICUs across two different healthcare systems using data from over 2 years. We will examine interprofessional team continuity of shift-level ICU clinician teams (a nurse, a physician, and a respiratory therapist) assigned to each patient during the ICU stay. We define two dimensions of team continuity: intra-professional continuity, measuring each of the clinician’s experience caring for the patient previously during the patient’s stay, and inter-professional continuity, measuring the clinicians’ joint experience working together as a team. We hypothesize that care delivered by shift-level ICU teams with higher intra- and inter-professional continuity will result in improved patient outcomes and reduced costs. Our research team has a strong record of joint publications on attributes of patient care teams including continuity of care with expertise in health economics, critical care nursing and medicine and engineering. Completion of the study will generate the most robust evidence, to date, to inform organizational priorities about continuity-based interprofessional staffing in ICUs, to improve care for critically ill ICU patients.

项目摘要 重症监护是最复杂，资源密集型和昂贵的护理环境，为全球贡献了超过1300亿美元， 每年的国家卫生支出。大约有400万病人被送进重症监护室 （ICU），平均死亡率为8-19。最近COVID-19强调， ICU的跨专业团队的人员配备非常具有挑战性。医疗保健人员配备的一个特点是， 在ICU之外的环境中受到很多关注的是护理的连续性- 长期以来，由专业人员组成的小团队一直被认为是高质量的基本属性， 以病人为中心的优质护理。在初级保健中，病人护理的连续性越高， 急诊科就诊和住院、更低的医疗保健成本和更高的患者满意度。 基于连续性的急性护理人员配置模式也存在，但在实践中很少被采用和维持， 特别是在ICU中，基于连续性的分配可能具有操作性。重要的是， 尽管重症监护由医生、护士和呼吸治疗师组成的跨专业团队提供， 跨专业ICU团队的连续性以前从未被概念化或测量过。没有这个 知识，很难知道医院和管理者是否应该优先考虑ICU护理的连续性， 这可能是一个错过的机会，以改善病人护理质量和结果，在这个危重病，昂贵的 患者人群。我们研究的总体目标是检查ICU连续性的效果 跨专业团队对病人的结果和组织的经济成果，以 开发一个专业间派任决策支持工具，优化 专业ICU团队护理我们建议审查跨专业团队的质量和成本 ICU的连续性人员配置方法，以指导两种不同医疗保健的13个ICU的未来干预 系统使用2年以上的数据。我们将研究轮班级别ICU的跨专业团队连续性 在ICU住院期间，分配给每位患者的临床医生团队（护士、医生和呼吸治疗师）。 我们定义了团队连续性的两个维度：专业内部的连续性，衡量每个临床医生的 在病人住院期间，有照顾病人的经验，以及专业人员之间的连续性， 测量临床医生作为一个团队一起工作的联合经验。我们假设， 具有更高的专业内和专业间连续性的轮班级别ICU团队将改善患者结局 和降低的成本。我们的研究团队在关于患者护理属性的联合出版物方面有着良好的记录 团队包括具有卫生经济学、重症监护护理和医学专业知识的连续性护理， 工程.完成这项研究将产生迄今为止最有力的证据， 优先考虑ICU中基于连续性的跨专业人员配置，以改善重症ICU患者的护理。