Evaluating the Implementation of Specialist Palliative Care for Patients with Advanced Heart Failure

评估对晚期心力衰竭患者实施专科姑息治疗的情况

• 批准号: 10930192
• 负责人: Shelli Leore Feder
• 金额: $ 57.15万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-23 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10930192
• 关键词: Accidents; Address; Administrator; American; American Heart Association; Cardiology; Caring; Case-Mix Adjustments; Characteristics; Clinical Practice Guideline; Consultations; Data; Data Set; Effectiveness; Electronic Health Record; Enrollment; Ensure; Evaluation; Family; Family member; Frequencies; Funding; Goals; Healthcare Systems; Heart Diseases; Heart failure; Hematological Disease; Hospice Care; Hospital Moving; Hospitalization; Hospitals; Interview; Joints; Knowledge; Life; Logistic Models; Lung diseases; Medical center; Medicare/Medicaid; Methods; Outcome; Palliative Care; Patient Care; Patients; Persons; Policies; Policy Analysis; Population; Population Programs; Process; Provider; Quality of Care; Recommendation; Reporting; Research; Sampling; Site; Sleep Disorders; Specialist; Standardization; Structure; Surveys; Symptoms; System; United States; United States Department of Veterans Affairs; Variant; Workload; care delivery; clinical practice; college; data infrastructure; data integration; design; deviant; end of life; end of life care; experience; hospice environment; implementation evaluation; implementation strategy; improved; indexing; innovation; novel; palliative; programs; structured data; uptake

Project Summary Over 280,000 people die from advanced heart failure each year in the United States. This population experiences burdensome symptoms, frequent hospitalizations, and delayed transitions to hospice care. Clinical practice guidelines recommend the use of palliative care for persons with advanced heart failure to address this population's many palliative care needs. However, nationally the uptake of specialist palliative care remains low, and implementation across hospitals varies widely, limiting effectiveness. As hospitals move to implement specialist palliative care into clinical practice for persons with advanced heart failure, there is little evidence to guide them as to what components are necessary or how to implement this care. Without such information, the uptake of specialist palliative care will remain low thereby contributing to poor care at the end of life. Our proposed project will address these critical knowledge gaps. Our long-term goal is to increase the low uptake of specialist palliative care and to improve end-of-life care quality among people with advanced heart failure. As a step towards this goal, the objective of this proposal is to identify modifiable factors and implementation strategies that medical centers can use to develop specialist palliative care programs for this population, beginning in the Department of Veterans Affairs (VA). The VA is the largest healthcare system in the United States and is the only healthcare system whose integrated electronic health record supports a rigorous and comprehensive evaluation of specialist palliative care delivery involving features of both palliative and cardiology practices. To accomplish our objectives, we will use a multisite, sequential, explanatory mixed methods design and a positive deviance approach. We will evaluate associations between specialist palliative care and cardiology program composition (i.e., structures) and operational characteristics (i.e., processes) and the uptake of specialist palliative care (Aim 1) and important outcomes of end-of-life care quality including hospice enrollment before the last seven days of life, and family-reported end-of-life care quality (Aim 2). We will accomplish these aims using a novel dataset comprised of patient and hospital-level data from 83 VA medical centers, detailed data on structures and processes of specialist palliative care and cardiology programs, and surveys of bereaved family members combined with Medicare and Medicaid claims. Next, we will compare structures, processes, and implementation strategies across twelve medical centers by conducting interviews with specialist palliative care and cardiology clinicians, and through the analysis of policy documents and consultation templates (Aim 3). We will integrate quantitative and qualitative data (Aim 4) to identify strategies that facilitate the effective delivery and implementation of specialist palliative care for persons with advanced heart failure. This proposal directly aligns with NOT-HL-20-737 by identifying real-world, pragmatic strategies that address barriers and facilitate sustained delivery of specialist palliative care. Findings from our project can inform and refine specialist palliative care programs nationwide for persons with advanced heart failure.

项目摘要 在美国，每年有超过28万人死于晚期心力衰竭。这些人经历了 难以负担的症状，频繁住院，延迟过渡到临终关怀。临床实践 指南建议对晚期心力衰竭患者使用姑息治疗来解决这一问题， 人口的许多姑息治疗的需要。然而，在全国范围内，专科姑息治疗的接受率仍然很低， 医院之间的实施差异很大，限制了有效性。随着医院开始实施 专家姑息治疗进入临床实践的人与先进的心脏衰竭，几乎没有证据表明， 指导他们了解哪些组件是必要的或如何实施这种护理。如果没有这些信息， 接受专科姑息治疗的人数仍然很少，从而导致临终护理质量差。我们 拟议的项目将解决这些关键的知识差距。我们的长期目标是提高低吸收率， 专家姑息治疗和提高晚期心力衰竭患者的临终护理质量。作为 作为实现这一目标的一个步骤，本提案的目的是确定可改变的因素和实施战略 医疗中心可以用来为这一人群制定专业的姑息治疗计划， 退伍军人事务部（VA）。VA是美国最大的医疗保健系统，也是 唯一的医疗保健系统，其集成的电子健康记录支持严格和全面的 评估专科姑息治疗服务，包括姑息治疗和心脏病学实践的特点。到 为了实现我们的目标，我们将使用多站点，顺序，解释性混合方法设计和积极的 异常方法我们将评估专科姑息治疗和心脏病学项目之间的关联 组合物（即，结构）和操作特性（即，和吸收专家 姑息治疗（目标1）和临终关怀质量的重要结果，包括临终关怀登记之前， 生命的最后7天，以及家庭报告的临终关怀质量（目标2）。我们将通过以下方式实现这些目标： 一个新的数据集，包括来自83个VA医疗中心的患者和医院级数据，详细数据 专家姑息治疗和心脏病方案的结构和过程，以及对死者家属的调查 与Medicare和Medicaid索赔相结合。接下来，我们将比较结构、流程和 通过与姑息治疗专家进行访谈，在12个医疗中心实施战略 和心脏病学临床医生，并通过分析政策文件和咨询模板（目标3）。我们 将结合定量和定性数据（目标4），以确定促进有效交付的战略 并为晚期心力衰竭患者提供专科姑息治疗。该提案直接 与NOT-HL-20-737保持一致，确定解决障碍和促进 持续提供专科姑息治疗。我们项目的发现可以为专家提供信息并改进姑息疗法 全国范围内针对晚期心力衰竭患者的护理方案。