Identification and Prevention of Potentially Inappropriate Inter-hospital Transfers

摘要 尽管假设医院间转运(IHT，急性护理之间的病人转运 医院)是为了向患者提供必要的专门护理，IHT也暴露了弱势群体 住院患者对中断护理的风险。我们最近的研究表明， 转移的患者在IHT期间可能会受到伤害，但没有明确的好处；然而，我们目前缺乏关于 如何识别哪些患者的伤害大于转移的好处，即经历不适当的IHT。 这项研究的长期目标是严格定义和评估发病率和患者 潜在不适当的IHT对住院内科患者的安全影响，识别有风险的患者 不适当的转移，并开发一个干预工具包，以减少潜在的不适当的IHT。要实现 为此，我们将与参与IHT的不同利益相关者合作，包括患者/家属、接受和入院 临床医生、转院临床医生和医院领导，以确定潜在的不适当的IHT。到时候我们会的 通过标准化判定确定潜在不适当的间歇性高血压的发生率和患者安全影响 来自18家美国医院的1800名住院患者参加了一项全国性的研究合作 (HomeRun)并向基准和采购组织(Vizient)提供数据。裁决工具 将基于类似的先前研究中使用的那些，并将由利益相关者的定义告知 潜在的不合时宜的IHT。我们将结合严格的审裁人员培训和持续审查，以确保 跨站点、审判者和时间的可靠性。然后，我们将使用标准建模技术来 基于以下几点回顾描述一个人群(S)潜在的不适当患者转移 患者、转院流程和系统层面的因素。这之后将是先进的机器学习 前瞻性识别存在潜在不适当IHT风险的患者的方法和模型的验证 性能。最后，我们将利用上述分析的关键结果和利益相关者的意见来创建 原型干预，基于来自参与站点的反馈，使用混合方法提炼原型 方法，并开发一个最佳做法工具包，以防止潜在的不适当的IHT(例如，通过替换它 使用更安全的替代方案)，以供未来传播。这项研究将建立一个基础， 医疗保健系统可以在适当的环境中为患者提供适当的护理，从而实现卓越。

ABSTRACT Despite assumptions that inter-hospital transfer (IHT, the transfer of patients between acute care hospitals) is done to provide patients with necessary specialized care, IHT also exposes vulnerable hospitalized patients to the risks of discontinuity of care. Our recent research suggests that a subset of transferred patients may experience harm during IHT without clear benefit; however, we currently lack data on how to identify in which patients harm outweighs benefit of transfer, i.e., experience inappropriate IHT. The long-term objective of this research is to rigorously define and evaluate the incidence and patient safety impact of potentially inappropriate IHT among hospitalized medical patients, identify patients at risk for inappropriate transfer, and develop an intervention toolkit to reduce potentially inappropriate IHT. To achieve this, we will work with diverse stakeholders involved in IHT, including patients/families, accepting and admitting clinicians, transferring clinicians, and hospital leadership to define potentially inappropriate IHT. We will then determine the incidence and patient safety impact of potentially inappropriate IHT via standardized adjudication of 1800 hospitalized medical patients from 18 US hospitals that participate in a national research collaborative (HOMERuN) and contribute data to a benchmarking and purchasing organization (Vizient). Adjudication tools will be based on those used in similar prior research and will be informed by stakeholder definitions of potentially inappropriate IHT. We will incorporate rigorous adjudicator training and continuous review to ensure reliability across sites, adjudicators, and time. We will then use standard modelling techniques to retrospectively characterize a population(s) of potentially inappropriate patient transfers based on several patient, transfer process, and system-level factors. This will be followed by advanced machine-learning methods to prospectively identify patients at risk for potentially inappropriate IHT and validation of the model's performance. Finally, we will utilize key results from the above analyses and stakeholder input to create a prototype intervention, refine the prototype based on feedback from participating sites using a mixed methods approach, and develop a toolkit of best practices to prevent potentially inappropriate IHT (e.g., by replacing it with a safer alternative) for future dissemination. This research will establish a foundation from which healthcare systems can achieve excellence in providing patients with the right care, in the right setting.