E-Coaching: IVR-Enhanced Care Transition Support for Complex Patients

描述(由申请人提供)：对于复杂的内科患者，从医院到家庭护理的过渡是一个脆弱的时期，将患者置于不良事件的高风险中，包括经历医疗错误或失去社区终身教职。最近成功的研究使用了护理过渡干预(CTI)，使用一名护士进行家访、电话随访，并在出院时和出院后提供帮助。虽然这种模式很成功，但成本很高，而且在为地理上分散的人口提供服务的环境中是不可行的。我们通过“e-Coach”提出了一种经济高效的技术解决方案，以解决传统CTI带来的问题，“e-Coach”是一种支持交互式语音应答(IVR)的护理过渡指导干预。我们建议开发和评估“e-Coach”，通过对这一干预措施与普通护理对照组进行随机对照试验。据我们所知，到目前为止，一种概念上基于IVR支持的护理过渡干预措施还没有经过严格的测试。我们的具体目标是：1)随机选择720名有过渡相关错误高危风险的患者(复杂的成年患者因充血性心力衰竭(CHF)或慢性阻塞性肺疾病(COPD)住院，从地理上不同的地区，包括阿拉巴马州和南部的许多农村地区，活着出院)到IVR支持的护理过渡计划(“e-Coach”)，与常规护理对照组进行比较。IVR系统将在出院后以多个间隔(前4周每天)主动呼叫患者。在分步护理方法中，IVR将得到护理过渡护士的进一步支持，该护士通过e-Coach IVR监控患者的症状，并在需要时通过电话互动支持患者自我管理，最长可达出院后2个月；2)评估患者和医疗保健提供者对e-Coach的使用；3)评估e-Coach对患者结局的影响，包括90天再次住院、3个月内成功的社区任期、用药差异和患者自我效能，基于先前验证的护理过渡衡量标准；以及4)量化与e-Coach相关的成本。如果e-Coach成功，它很可能很容易传播，并可能导致在医院到家庭的过渡期内大量避免医疗差错，同时显著降低再次住院的风险和成本。

DESCRIPTION (Provided by Applicant): For complex medical patients, the transition from hospital to home-based care is a vulnerable period, placing the patient at high risk for adverse events, including the experience of a medical error or loss of community tenure. Recent successful studies have used a Care Transition Intervention (CTI), using a nurse who conducts home visits, telephone follow-up, and who provides assistance at and after discharge. Although successful, this model is costly and is not feasible in settings serving geographically dispersed populations. We propose a cost-efficient technological solution to the problems presented by the traditional CTI through "e-Coach," an Interactive-Voice-Response-supported (IVR) Care Transition coaching intervention. We propose to develop and evaluate "e-Coach," by performing a randomized controlled trial of this intervention versus a usual care comparison group. To our knowledge, a conceptually grounded IVR-supported care transition intervention has not, to date, been rigorously tested. Our Specific Aims are to: 1) Randomize 720 patients at high risk of transition-related errors (complex adult patients discharged alive after a hospitalization with congestive heart failure (CHF) or chronic obstructive pulmonary (COPD) disease from a geographically diverse area including many rural areas across Alabama and the South) to an IVR-supported care transition program ("e-Coach") versus a usual care comparison group. The IVR system will actively call patients at multiple (daily for first 4 weeks) intervals after discharge. In a stepped-care approach, the IVR will be further supported by a Care Transition nurse who monitors patient symptoms through the e-Coach IVR and supports patient self management through telephone-based interactions when needed, up to 2 months after discharge; 2) Evaluate use of the e-Coach by patients and healthcare providers; 3) Evaluate the impact of the e-Coach on patient outcomes, including 90 day re-hospitalizations, successful community tenure over a 3 month period, medication discrepancies, and patient self-efficacy based on the previously validated Care Transition Measure; and 4) Quantify the cost associated with the e-Coach. If e-Coach is successful, it is likely to be easily disseminated and could result in substantial avoidance of medical errors in the hospital-to-home transition period along with notable reductions in the risks and costs of re-hospitalizations.