Improving Safety for Ambulatory Surgical Seniors

 描述(由申请人提供)：De Oliveira博士是西北大学范伯格医学院麻醉学系和医疗保健研究中心(CHS)公共卫生和医学研究所的助理教授。CHS通过健康服务和成果研究人员的跨学科、多部门合作，开展关于医疗保健安全和质量的尖端研究，以告知和塑造医疗保健政策，并改善医疗保健实践和国家健康。De Oliveira博士的长期目标是成为围手术期健康服务研究的独立调查者，并从事研究，以改善以患者为中心的护理，为脆弱的围手术期患者提供医疗保健安全和质量。在过去的十年里，美国在门诊护理环境中进行的手术数量增加了300%以上，每年有超过600万例老年人进行门诊手术。De Oliveira博士在之前的一项工作中已经证明，年龄的增加直接和独立地与门诊手术(AS)后意外住院人数增加54%有关。此外，De Oliveira博士提供了初步证据，表明老年人在AS后自行使用阿片类药物时，对术后指导的依从性较差，经常出现用药错误。尽管如此，尚不清楚哪些特定的风险因素使老年人在AS后更容易受到不良安全和质量结果的影响。De Oliveira博士假设，基于已确定的危险因素的以患者为中心的、多维的过渡护理干预将改善AS后老年人出院后的安全性和质量。在ORDR中，该项目的目标是：1)确定老年人门诊手术后出院后安全性和质量结果差的风险因素；2)开发以患者为中心的多维护理干预过渡，以提高接受门诊手术的老年人的安全性和质量；3)进行门诊手术护理干预过渡的可行性研究。通过这个奖项，De Oliveira博士打算：(1)通过设计针对低识字率患者的围术期健康教育工具，获得健康素养研究方面的知识；(2)通过为非卧床外科老年人开发汽车干预的新转变，获得患者安全研究技能；(3)通过开展老年人和其他门诊外科利益相关者的焦点小组，完善护理干预措施的转变，获得定性研究方法方面的专业知识；以及(4)通过在三级城市护理医院实施新型干预措施，提高实施科学方面的熟练程度。这一职业发展应用与AHRQ的两个优先重点领域直接一致：1)通过加快实施以患者为中心的结果研究来提高医疗质量；2)使医疗更安全。此外，该项目将研究和吸引老年人，这是AHRQ的优先群体。

 DESCRIPTION (provided by applicant): Dr. De Oliveira is an Assistant Professor in the Department of Anesthesiology and at the Center for HealthCare Studies (CHS) -Institute for Public Health and Medicine at Northwestern University, Feinberg School of Medicine. CHS conducts cutting-edge research about the safety and quality of healthcare through interdisciplinary, multi-departmental collaborations of health services and outcomes researchers in order to inform and shape healthcare policy and to improve healthcare practices and the health of the nation. Dr. De Oliveira's long-term goal is to become an independent investigator in perioperative health services research and engage in research to improve patient centeredness of care, healthcare safety and quality for vulnerable perioperative patients. The number of surgeries performed in the ambulatory care setting in the US has increased by over 300 percent in the last decade with over 6 million ambulatory surgeries performed in seniors, annually. Dr. De Oliveira has demonstrated in a prior work that increased age is directly and independently associated with a 54% increase in unanticipated hospital admissions after ambulatory surgery (AS). In addition, Dr. De Oliveira provides preliminary evidence that seniors have poor adherence to post-surgical instructions and frequently commit medication errors when self-administering opioids after AS. Nonetheless, it is not known which specific risk factors make seniors more vulnerable to poor safety and quality outcomes after AS. Dr. De Oliveira hypothesizes that a patient-centered, multidimensional, transition of care intervention based on identified risk factors will improve post-discharge safety and quality for seniors after AS. In ordr to address the hypothesis, the project AIMs are to: 1) Determine the risk factors for poor post-discharge safety and quality outcomes in seniors after ambulatory surgery 2) Develop a patient-centered multidimensional transition of care intervention to improve safety and quality for seniors undergoing ambulatory surgery, and 3) Conduct a feasibility study of the ambulatory surgery transition of care intervention. With this award, Dr. De Oliveira intends to: (1) gain knowledge in health literacy research by designing perioperative health educational tools to low literacy patients, (2) acquire patient safety research skills by developing a new transition of car intervention for ambulatory surgical seniors , (3) obtain expertise in qualitative research methods by performing focus groups of seniors and other ambulatory surgery stakeholders to refine the transition of care intervention , and (4) develop proficiency in implementation science by implementing the novel intervention in a tertiary urban care hospital. This career development application directly aligns with two AHRQ's priority areas of focus: 1) improve health-care quality by accelerating implementation of patient-centered outcomes research and 2) make health-care safer. In addition, the project will study and engage seniors, a priority population for AHRQ.