A quality and cost analysis of interprofessional team continuity in ICUs

项目摘要 重症监护是最复杂、资源密集型和昂贵的护理环境，为 每年的国家卫生支出。大约有400万病人被送进重症监护室。 (ICU)，平均死亡率在8-19之间。最近，新冠肺炎强调， ICU中跨专业团队的人员配置是相当具有挑战性的。医疗保健人员配备的一个特点是 在ICU以外的环境中，受到很大关注的是护理的连续性--即患者由 随着时间的推移，由确定的专业人员组成的小团队-长期以来一直被认为是高- 优质、以患者为中心的护理。在初级保健中，患者护理的连续性越强，与之相关的就越少 急诊科就诊和住院、更低的医疗成本和更高的患者满意度。 基于连续性的急性护理人员配置模式也存在，但在实践中很少被采用和维持， 特别是在以连续性为基础的任务难以实施的重症监护室。重要的是 虽然重症监护是由医生、护士和呼吸治疗师组成的跨专业团队提供的， 跨专业ICU团队的连续性以前从未被概念化或衡量过。如果没有这个 知识，很难知道医院和管理人员是否应该优先考虑ICU护理的连续性， 这可能是一个错过的机会，以改善患者的护理质量和结果在这个危重的，昂贵的 病人群体。我们研究的总体目标是检查ICU连续性的影响 关于患者结果和组织经济结果的跨专业团队，以便 开发跨专业人员分配决策支持工具，以优化 跨专业ICU团队护理。我们建议检查一个跨专业团队的质量和成本。 ICU中的连续性人员配置方法，以指导两种不同医疗保健领域的13个ICU的未来干预 系统使用超过2年的数据。我们将研究班级ICU的跨专业团队连续性 在ICU期间分配给每个患者的临床医生团队(一名护士、一名内科医生和一名呼吸治疗师)。 我们定义了团队连续性的两个维度：专业内连续性，衡量每个临床医生的 以前在病人住院期间照顾病人的经验，以及跨专业的连续性， 测量临床医生作为团队一起工作的联合体验。我们假设护理是由 具有更高专业内和专业间连续性的班级ICU团队将带来更好的患者预后 并降低了成本。我们的研究团队有关于患者护理属性的联合出版物的良好记录 包括连续性护理的团队，具有卫生经济、重症护理护理和医学方面的专业知识 工程学。这项研究的完成将产生迄今为止最有力的证据，为组织提供信息 关于ICU中基于连续性的跨专业人员配置的优先事项，以改善对重症ICU患者的护理。

PROJECT ABSTRACT Critical care is the most complex, resource-intensive and costly care setting contributing over $130 billion to national health expenditures annually. Approximately 4 million patients are admitted to intensive care units (ICUs) each year with average mortality rate ranging from 8-19. Recently COVID-19 has highlighted that staffing interprofessional teams in ICUs is quite challenging. One feature of healthcare staffing that has received much attention in settings outside of the ICU is continuity of care – whereby a patient is cared for by a small team of identified professionals over time – has been long recognized as an essential attribute of high- quality, patient-centered care. In primary care, greater continuity of patient care is associated with fewer emergency department visits and hospitalizations, lower healthcare costs, and higher patient satisfaction. Continuity-based acute care staffing models also exist, but are rarely adopted and sustained in practice, particularly in ICUs where continuity-based assignments can be challenging to operationalize. Importantly, although critical care is delivered by interprofessional teams of physicians, nurses, and respiratory therapists, continuity of interprofessional ICU teams has never been conceptualized or measured before. Without this knowledge, it is difficult to know whether hospitals and administrators should prioritize continuity of ICU care, which could be a missed opportunity to improve quality of patient care and outcomes in this critically ill, costly patient population. The overall goal of our study is to examine the effect of continuity of ICU interprofessional teams on patient outcomes and organizational economic outcomes, in order to develop an interprofessional assignment decision-support tool that optimizes the continuity of interprofessional ICU team care. We propose to examine the quality and costs of an interprofessional team continuity staffing approach in ICUs to guide future interventions in 13 ICUs across two different healthcare systems using data from over 2 years. We will examine interprofessional team continuity of shift-level ICU clinician teams (a nurse, a physician, and a respiratory therapist) assigned to each patient during the ICU stay. We define two dimensions of team continuity: intra-professional continuity, measuring each of the clinician’s experience caring for the patient previously during the patient’s stay, and inter-professional continuity, measuring the clinicians’ joint experience working together as a team. We hypothesize that care delivered by shift-level ICU teams with higher intra- and inter-professional continuity will result in improved patient outcomes and reduced costs. Our research team has a strong record of joint publications on attributes of patient care teams including continuity of care with expertise in health economics, critical care nursing and medicine and engineering. Completion of the study will generate the most robust evidence, to date, to inform organizational priorities about continuity-based interprofessional staffing in ICUs, to improve care for critically ill ICU patients.