Determining Key Organizational Health Communication Practices in Complex Patients

 描述（由申请人提供）：新出现的证据表明，以患者为中心的沟通实践对于提供高质量、可靠和安全的患者护理至关重要。然而，尽管试验证明了以患者为中心的具体沟通策略的有效性，但医疗保健系统内的实践实施情况很差。一个原因可能是组织没有优先考虑或支持以患者为中心的沟通实践。推进研究，以确定组织以患者为中心的沟通气氛和患者的结果之间的关系是至关重要的，以证明其价值，并确定机制，从而修改组织以患者为中心的沟通气氛将有最大的影响。本建议的目标是推进理解的做法，决定因素和相关的病人的结果，组织以病人为中心的沟通氛围。终末期肾病（ESRD）和提供维持生命的透析治疗提供了一个独特的和强大的设置，以检查组织的沟通气氛。ESRD患者的死亡率、住院率和生活质量均显著较高。尽管透析护理技术取得了进步，但结果仍然很差，这表明需要新的策略来改善患者健康。我们假设，组织的沟通气氛有助于显着个人患者报告和临床结果，并可能克服弱势患者之间的结果差异。我们将利用透析结局和实践模式研究（DOPPS）的资源，DOPPS是自1996年以来在21个国家进行的代表性前瞻性国际队列研究，旨在确定与改善患者结局相关的可修改透析实践。为了验证我们的假设，本研究的目的是：1）在200家透析机构和1400名患者中，描述组织中以患者为中心的沟通氛围及其与患者对提供者沟通、透析知识、自我效能和自我护理行为的满意度的关系; 2）在前瞻性队列中检查组织性患者-以465家透析机构和15，000名患者的临床结局为中心的沟通氛围;以及3）确定透析机构组织沟通氛围是否会改变年龄、种族或健康素养相关差异和结局的相关性。我们是一个综合的，多元化的研究团队，装备精良，独特的准备，有效地利用现有的基础设施，以促进健康沟通，组织行为和透析研究。这一建议将有助于未来的研究，通过推进我们的机制和影响的透析护理组织的沟通气氛的理解，评估一个新的框架描绘其作用，并产生有效的评估方法。这项研究将进一步为未来开发和测试高效和有效的多层次干预措施提供信息，以连接患者，提供者和卫生系统，以优化质量计划和以患者为中心的护理。

 DESCRIPTION (provided by applicant): Emerging evidence suggests that patient-centered communication practices are essential to the delivery of high quality, reliable and safe patient care. However, despite trials demonstrating the efficacy of specific patient-centered communication strategies, implementation of practices within healthcare systems is poor. A reason may be that an organization does not prioritize or support patient-centered communication practices. Advancing research to determine the relationship between organizational patient-centered communication climate and patient outcomes is critical to demonstrate its value and to identify mechanisms whereby modifying organizational patient-centered communication climate will have the most impact. The goal of this proposal is to advance understanding of the practices, determinants and associated patient outcomes of organizational patient-centered communication climate. End-stage renal disease (ESRD) and the provision of life-sustaining dialysis treatment provides a unique and robust setting to examine organizational communication climate. Patients with ESRD are at significantly higher risk for mortality, hospitalization, and poor quality of life. Despite advances in the technology o dialysis care, outcomes are persistently poor indicating the need for novel strategies to improve patient health. We hypothesize that organizational communication climate contributes significantly to individual patient reported and clinical outcomes, and may overcome disparities in outcomes among vulnerable patients. We will leverage the resources of the Dialysis Outcomes and Practice Patterns Study (DOPPS), a representative prospective international cohort study since 1996, in 21 countries, aimed to identify modifiable dialysis practices associated with improved patient outcomes. To address our hypothesis, the aims are: 1) To characterize organizational patient-centered communication climate and its association with patients' satisfaction with provider communication, dialysis knowledge, self-efficacy, and self-care behaviors in 200 dialysis facilities and 1400 patients; 2) To examine in a prospective cohort the association of organizational patient-centered communication climate with clinical outcomes in 465 dialysis facilities and 15,000 patients; and 3) To determine if dialysis facility organizational communication climate modifies associations of age, race, or health-literacy related disparities and outcomes. We are an integrated, diverse research team well equipped and uniquely poised to efficiently leverage existing infrastructure to advance health communication, organizational behavior and dialysis research. This proposal will serve future research by advancing our understanding of mechanisms and impact of organizational communication climate in dialysis care, evaluating a novel framework depicting its role, and also generating efficient assessment methods. This research will further inform the future development and testing of efficient and effective multi-level interventions to connect patients, providers and health systems to optimize quality programs and patient-centered care.