Engaging Patients and Providers in Identifying and Addressing Modifiable Risk Factors to Prevent Community-Acquired Ulcers in Veterans with SCI

这项研究的目标是确定并开始应对预防社区-- 脊髓损伤(SCI)患者获得性压疮 护理者和提供者感知的风险因素。我们将探索退伍军人和照顾者对CAPrU的看法 使用参与性行动研究[PAR](PhotoVoice，导游)方法的风险因素和提供者 个人访谈的视角。我们将比较SCI提供者对CAPrU风险因素的看法与 退伍军人和照顾者的。我们将领导一个由专家小组成员组成的德尔福小组来制定，以及 在脊髓损伤门诊试行CAPrU风险评估核对表工具。 我们目前的医疗保健系统是支离破碎的，完善的HAPrU预防策略 没有定义、翻译、扩展或适应门诊设置，也没有行动和社区 已确定资源以支持社区中的溃疡预防活动。我们的研究理论基础是 美国预防服务工作组(USPSTF)建议1和国际移民组织的逻辑相同 报告《犯错是人》推动发展循证决策支持工具，培养有意义的 以患者为中心的生产性互动，预防CAPrU的2，3生产性互动从参与开始 患者和提供者在识别可修改的风险因素、操作和资源方面的作用。建议的清单是 确定CAPrU风险、行动和资源的手段，以刺激社区的预防活动。 目标1和2重点确保核对表以患者为中心，解决患者和患者之间的差距 提供者的观点，并且对于社区设置是实用的和相关的。AIM 3将评估是否 将检查表纳入脊髓损伤门诊增加CAPrU预防性护理的提供/接收 及其对新CAPrU的影响。我们提出的CAPrU检查表是实现患者-提供者共同目标的桥梁 在诊所设置和在社区开展预防驾驶活动。 我们会找出需要采取的行动和所需的资源，以落实现行的保诚预防指引。 社区/家庭环境：1)识别和比较利益相关者(患者、照顾者、提供者)的心理 应对CAPrU风险因素的挑战模型，2)召集利益攸关方专家小组(例如， 退伍军人、护理员、提供者和国家PRU预防专家)来开发和验证风险因素 核对表工具，包括防止CAPrU所需的特定操作和资源，以及3)评估 门诊脊髓损伤危险因素检查表的可行性、可接受性、有效性和安全性 融入脊髓损伤门诊的工作/病人流程。 在USPSTF建议和瓦格纳慢性护理模式的指导下进行改进 管理复杂的慢性病，我们将创建一个风险评估决策支持工具，以确定 风险、行动和资源，以促进患者、照顾者和提供者之间的有效互动。 我们将使用混合方法来创建该工具，并在SCI中进行该工具的事后可行性试验 门诊部。[我们还将在所有3个研究地点检查该工具对新的CAPrU发病率的影响。] 研究产品包括：1)iPad应用程序，可自动执行风险因素核对表工具并支持 供应商记录风险因素和PrU预防措施、具体措施和所需资源 防止CAPrU在门诊使用；2)实施iPad核对表工具的研究方案 在SCI门诊期间；以及3)向退伍军人和SCI提供者告知风险因素的案例研究 与新的CAPrU相关联。这项研究将创建一个更一致的方法来处理CAPrU风险因素和 预防性护理将在未来的研究中进行评估。

The objective of this study is to identify and begin to address the challenges of preventing community- acquired pressure ulcer (CAPrUs) in individuals living with spinal cord injury (SCI) by exploring patient, caregiver, and provider perceived risk factors. We will explore Veteran and caregiver perceptions of CAPrU risk factors using participatory action research [PAR] (photovoice, guided tour) methods and provider perspectives with individual interviews. We will compare SCI providers' perceptions of CAPrU risk factors with those of Veterans and caregivers. We will conduct a Delphi panel with expert panel members to develop, and pilot a risk assessment checklist tool for CAPrUs in an SCI outpatient clinic. Our current health care system is fragmented and well-established HAPrU prevention strategies have not been defined, translated, expanded on or adapted to the outpatient setting, nor have actions and community resources been identified to support ulcer prevention activities in the community. Our study rationale builds on the same logic underlying the U.S. Preventive Services Task Force (USPSTF) recommendations1 and the IOM report, “To Err Is Human” promote developing evidence-based decision support tools to foster meaningful patient-centered productive interactions,2,3 Productive interactions in preventing CAPrUs begin by engaging patient and provider in identifying modifiable risk factors, actions and resources. The proposed checklist is the means for identifying CAPrU risks, actions and resources to stimulate prevention activities in the community. Aims 1 & 2 focus on ensuring the checklist is patient-centered, addresses gaps between the patient and provider perspectives, and is practical and relevant for the community setting. Aim 3 will evaluate whether integrating the checklist into SCI outpatient encounters increases the provision/receipt of CAPrU preventive care and its' impact on new CAPrUs. Our proposed CAPrU checklist is the bridge for patient-provider mutual goal setting in the clinic and for driving prevention activities in the community. We will identify actions and resources needed to operationalize the existing PrU prevention guidelines to community/home settings by: 1) identifying and comparing stakeholder (patient, caregiver, provider) mental models of the challenges in addressing CAPrU risk factors, 2) convening an expert panel of stakeholders (e.g., Veterans, caregivers, providers, and national PrU prevention experts) to develop and validate a risk factor checklist tool that includes specific actions and resources needed to prevent CAPrUs, and 3) evaluating the risk factor checklist tool in an outpatient SCI clinic to determine the feasibility, acceptability, efficacy and integration into work/patient flow in an SCI outpatient clinic. Guided by the USPSTF recommendations and the Wagner Chronic Care Model for improving management of complex chronic conditions, we will create a risk assessment decision support tool to identify risks, actions and resources to promote productive interactions between patients, caregivers and providers. We will use mixed methods to create the tool and conduct a pre-post feasibility trial of that tool in an SCI outpatient clinic. [We will also examine the effect of the tool on new CAPrU incidence at all 3 study sites.] Study products include: 1) an iPad application that automates the risk factor checklist tool and supports provider documentation of risk factors and PrU preventive actions, specific actions and resources needed to prevent CAPrUs for use in the outpatient clinic; 2) a study protocol for implementing the iPad checklist tool during SCI outpatient encounters; and 3) case studies to inform Veterans and SCI providers about risk factors associated with new CAPrUs. This study will create a more consistent approach to CAPrU risk factors and preventive care to be evaluated in a future study.