EVIDENCE-BASED 'REMINDERS' IN HOME HEALTH CARE

这个项目将测试两种替代的基于信息的战略的相对有效性和成本效益，这些战略旨在改善提供者的业绩，并促进家庭保健护士遵守循证实践指南。将对两种示踪性疾病--充血性心力衰竭和癌症疼痛--测试两种干预措施--一种是“基本的”干预措施，另一种是增强干预措施。基本干预和增强干预都将提供电子邮件提醒，强调护士应遵循的四到六种具体情况的做法，以实现最佳的患者结果。然而，这两种干预措施在提供信息的范围和“专家同行”的可用性方面将有所不同。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。这种干预属于计算机化提醒策略的一类，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贯有效。增强的干预将大大扩大护士可获得的信息和资源。除了及时的电子邮件提醒外，这一多方面的干预将包括分发全面的临床指南(家庭计划)、患者教育材料，以及临床护士专家(CNS)的后续电子邮件联系和外展，他将作为“专家同行”。这项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)。该分析将评估干预措施对护理实践和护理过程、对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、患者访谈和行政档案。对(两种干预措施)经回归调整的治疗-控制组差异的估计将确定提供者实践、患者结果和成本的差异在多大程度上可归因于替代的基于信息的策略。该项目最后将讨论我们的成本效益调查结果对家庭护理政策和计划倡议的影响。

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.