Evaluating the Role of Telemedicine in Improving Rural Emergency Department Sepsis Care

项目总结/摘要 脓毒症是一种危及生命的疾病，在过去十年中发病率翻了一番，现在构成了 美国所有住院死亡的17%，每年花费240亿美元。早期积极的紧急护理 可以挽救生命，但许多农村医院对循证败血症护理指南的依从性很低。 因此，农村脓毒症患者的死亡率高出38%。农村急诊科（艾德）为主 远程医疗已被提议用于标准化护理和支持农村医院的当地临床医生，但其 有效性从未经过严格测试。19%的美国人口生活在农村地区， 估计在美国每年有5,000例可预防的农村败血症死亡，迫切需要测试策略， 改善农村中心循证败血症指南的传播和实施。的目标 这个职业发展奖是准备申请人的职业生涯作为一个临床研究和健康 服务研究人员，重点是农村急性护理干预措施的比较有效性研究。这一目标 将在农村远程医疗研究中心的基础设施内通过以下方式实现：（a）具体的 研究生课程，（B）导师咨询委员会，（c）精心挑选的会议和 讲习班，以及（d）一项有指导的研究。拟议研究的具体目标是：（1）测量 基于ED的远程医疗使用、指南依从性和临床结局之间的关联，（2）测量 远程医疗关系对接受远程医疗的患者遵守指南的影响 可用但未使用，以及（3）描述远程医疗使用如何以及为什么影响临床护理，决策- 采用定性方法，制定和传播最佳做法。拟议的指导研究 该项目将通过对严重脓毒症患者进行观察性队列研究， 在中西部一个大型远程医疗网络中，在关键接入医院治疗的败血性休克超过4年 期我们的中心假设是，远程医疗将通过提高依从性来改善临床结果 通过改变（1）患者层面的建议，（2）提供者层面的行为， （3）医院层面的实践。在这个职业发展奖结束时，候选人将很好- 准备成为一个独立的科学家，在农村急性败血症护理的专业知识，在特定的优势， 比较有效性研究方法和定性研究方法。我们的研究结果将作为 为今后开展研究以了解传播战略（包括远程医疗）在 在农村卫生保健环境中实施最佳做法，这将成为候选人第一个 R 01提交。

Project Summary/Abstract Sepsis is a life-threatening condition that has doubled in incidence over the past decade, and now constitutes 17% of all in-hospital deaths in the US at an annual cost of $24 billion. Early, aggressive emergency care saves lives, yet many rural hospitals have low adherence to evidence-based sepsis care guidelines. Consequently rural sepsis patients have a 38% higher mortality rate. Rural emergency department (ED)-based telemedicine has been proposed to standardize care and support local clinicians in rural hospitals, but its effectiveness has never been rigorously tested. With 19% of the US population living in rural areas and an estimated 5,000 preventable rural sepsis deaths annually in the US, there is a critical need to test strategies to improve dissemination and implementation of evidence-based sepsis guidelines in rural centers. The goal of this Career Development Award is to prepare the applicant for a career as a clinical investigator and health services researcher focusing on comparative effectiveness research of rural acute care interventions. This goal will be accomplished within the infrastructure of the Rural Telehealth Research Center through (a) specific graduate coursework, (b) a Mentorship Advisory Committee, (c) carefully selected conferences and workshops, and (d) a mentored research study. The specific aims of the proposed study are (1) to measure the association between ED-based telemedicine use, guideline adherence, and clinical outcomes, (2) to measure the effect of a telemedicine relationship on guideline adherence among patients who have telemedicine available but not used, and (3) to describe how and why telemedicine use affects clinical care, decision- making, and dissemination of best practices, using qualitative methods. The proposed mentored research project will accomplish these aims through an observational cohort study of patients with severe sepsis or septic shock treated in critical access hospitals in a large Midwestern telemedicine network over a 4-year period. Our central hypothesis is that telemedicine will improve clinical outcomes through improved adherence with international sepsis guidelines by changing (1) patient-level recommendations, (2) provider-level behavior, and (3) hospital-level practices. At the end of this Career Development Award, the candidate will be well- prepared to become an independent scientist with expertise in rural acute sepsis care, with specific strength in comparative effectiveness research methods and qualitative methods. Our study findings will serve as the basis for future studies to understand the role of dissemination strategies (including telemedicine) on implementing best practices in rural health care settings, which will form the foundation of the candidate's first R01 submission.