EVIDENCE BASED REMINDERS IN HOME HEALTH CARE

该项目将测试两种替代的信息为基础的策略，旨在提高供应商的性能和促进家庭保健护士之间的循证实践指南的相对有效性和成本效益。 两种干预措施将进行测试-“基本”和增强干预-两个示踪条件：充血性心力衰竭和癌症疼痛。 基本和增强干预措施都将提供一个电子邮件提醒，强调护士应该遵循的四到六个特定条件的做法，以实现最佳的病人结果。 然而，这两种干预措施在提供信息的范围和是否有“专家同行”方面有所不同。“基本干预将在护士评估新的CHF或癌症疼痛患者后不久为她提供适用的临床指南的一次性提醒。 这种干预福尔斯属于计算机提醒策略的范畴，这些策略被发现在促进其他卫生专业人员的行为改变方面一直有效。 增强的干预将大大扩展护士可用的信息和资源。 除了及时的电子邮件提醒外，这一多方面的干预措施将包括分发一份全面的临床指南（HOME计划）、患者教育材料，以及由一名临床护士专家（CNS）作为“专家同行”进行后续电子邮件联系和外联。 本研究将采用随机设计，将护士分配到其中一个治疗组或对照组（常规护理）。 该分析将估计干预措施对护理实践和护理过程、患者结局和成本的影响。 这些因变量的测量将从主要和次要数据的组合中得出，包括患者记录、患者评估（OASIS）工具、患者访谈和管理文件。 回归调整的治疗-对照组差异（两种干预措施）的估计值将确定提供者实践、患者结局和成本的差异在多大程度上归因于替代性基于信息的策略。 该项目将结束与家庭护理政策和计划倡议的成本效益的研究结果的影响进行讨论。

This project will test the relative effectiveness and cost-effectiveness of two alternative information-based strategies designed to improve provider performance and promote adherence to evidence-based practice guidelines among home health care nurses. Two interventions will be tested - a "basic" and an augmented intervention - on two tracer conditions: congestive heart failure and cancer pain. Both basic and augmented interventions will provide an e-mail reminder highlighting four to six condition-specific practices that nurses should follow to achieve optimal patient outcomes. The two interventions will differ, however, with respect to the extent of information provided and the availability of an "expert peer." The basic intervention will provide the nurse with a one-time reminder of applicable clinical guidelines shortly after her assessment of a new CHF or cancer pain patient. This intervention falls within the class of computerized reminder strategies that were found to be consistently effective in promoting change in behavior among other health professionals. The augmented intervention will substantially expand the information and resources available to the nurse. In addition to the just-in-time e-mail reminder, this multifaceted intervention will include the distribution of a comprehensive clinical guideline (HOME Plan), patient education materials, and follow-up e-mail contact and outreach by a Clinical Nurse Specialist (CNS), who will serve as an "expert peer". The study will employ a randomized design that assigns nurses to either one of the treatment groups or to a control group (usual care). The analysis will estimate the impact of the interventions on nursing practices and processes of care, on patient outcomes, and on costs. Measures of these dependent variables will be derived from a combination of primary and secondary data, including patient records, patient assessment (OASIS) instruments, patient interviews, and administrative files. Estimates of regression-adjusted treatment-control group differences (for both interventions) will determine the extent to which differences in provider practice, patient outcomes and costs are attributable to the alternative information-based strategies. The project will conclude with a discussion of the implications of our cost-effectiveness findings for home care policy and program initiatives.