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HF Patient Decision Making Prior to Rehospitalization

心衰患者再住院前的决策

基本信息

批准号：
8787020
负责人：
Jiayun Xu
金额：
$ 3.74万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-12-01 至 2015-08-31
项目状态：
已结题

项目摘要

DESCRIPTION (provided by applicant): Rehospitalizations among heart failure (HF) patients are common due to a HF trajectory marked by sudden, acute exacerbations of illness. Nearly 1/5 of HF patients with Medicare are rehospitalized within 30 days of discharge, contributing to United States (US) HF costs of nearly 40 billion dollars a year. With the aging of the baby boomer population, these costs will rapidly increase in the future. Recent Medicare reimbursement changes place heavy penalties for 30 day hospitalizations related to HF, adding to the increasing financial burden of HF on the health care system. Despite efforts to prevent unnecessary HF hospitalizations through increased HF education, medical support after discharge, and telehealth programs, rehospitalization rates remain high. Current hospitalization prediction models for HF use patient characteristics (e.g. age, race, comorbidities) that do not consistently or strongly predict readmission -suggesting the need to examine and explore other patient characteristics such as medical decision making. Decision making in HF patients prior to being rehospitalized is complex, multifaceted, and poorly understood. In 2012, the American Heart Association (AHA) scientific report on decision making in advanced HF, identified the critical need for clinicians to understand HF patient decision making to promote effective, timely, efficient, and safe patient-centered care. Additionally, it is unknown if decision making processes differ between HF patients who have been rehospitalized within and beyond 30 days. The main goal of the study is to compare: (1) HF self-care, (2) decisional delays, and (3) decisions prior to hospitalization between HF patients who are rehospitalized within and beyond 30 days. The study, guided by a modified naturalistic decision making framework, uses a convergent parallel mixed-methods design to gain an in-depth understanding of the HF patient's decision making process with a focus on the critical modifiable variables of self-care and decisional delay. HF patients will be asked to complete a survey and participate in an interview about their decision making prior to rehospitalization. The proposed study is directly aligned with the National Institute of Nursing Research's (NINR) strategic plan to develop strategies that assist patients in better managing their chronic illness.

描述（由申请人提供）：由于以疾病突然急性加重为标志的HF轨迹，心力衰竭（HF）患者的再住院很常见。近1/5的医疗保险HF患者在出院后30天内再次住院，导致美国（US）HF费用每年近400亿美元。随着婴儿潮一代人口的老龄化，这些成本将在未来迅速增加。最近的医疗保险报销变化对与HF相关的30天住院治疗进行了严厉的处罚，增加了HF对医疗保健系统的日益增加的经济负担。尽管通过增加HF教育、出院后医疗支持和远程医疗计划努力防止不必要的HF住院，但再住院率仍然很高。目前HF的住院预测模型使用的患者特征（例如年龄、种族、合并症）不能一致或强烈预测再入院-这表明需要检查和探索其他患者特征，例如医疗决策。心力衰竭患者在再次住院前的决策是复杂的、多方面的，而且人们对此知之甚少。2012年，美国心脏协会（AHA）关于晚期HF决策的科学报告指出，临床医生迫切需要了解HF患者的决策，以促进有效，及时，高效安全的以病人为中心的护理此外，尚不清楚在30天内和30天后再次住院的HF患者之间的决策过程是否存在差异。本研究的主要目的是比较：（1）HF自我护理，（2）决策延迟，（3）在30天内和30天后再次住院的HF患者之间的住院前决策。这项研究，修改后的自然主义决策框架的指导下，使用收敛并行混合方法设计，以深入了解HF患者的决策过程，重点是自我护理和决策延迟的关键可变变量。HF患者将被要求完成一项调查，并参加一次关于其再住院前决策的访谈。拟议的研究直接与国家护理研究所（NINR）的战略计划，以制定战略，帮助患者更好地管理他们的慢性疾病。