Improving Transitional Care for Veterans Discharged to Post-acute Care Facilities

改善出院到急性后护理机构的退伍军人的过渡护理

基本信息

批准号：
10173876
负责人：
Robert Edward Burke
金额：
--
依托单位：
VA EASTERN COLORADO HEALTH CARE SYSTEM
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-10-01 至 2020-09-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10173876
关键词：
Accident and Emergency department Activities of Daily Living Acute Address Admission activity Advance Care Planning Affect Award Back Caring Cessation of life Chronic Clinical Code Colorado Communities Contracts Data Data Analyses Data Set Development Disabled Persons Discharge Plannings Elderly Emergency department visit Ensure Evaluation Funding Geriatrics Guidelines Health Health Services Accessibility Health care facility Healthcare Systems Home environment Hospital Mortality Hospital Planning Hospitalists Hospitalization Hospitals Independent Living Intervention Interview K-Series Research Career Programs Lead Length of Stay Link Literature Long-Term Care Measures Medicare Mentors Mentorship Methods Mission Monitor Myocardial Ischemia Nurses Nursing Homes Outcome Outcomes Research Patient Monitoring Patient Monitoring System Patient risk Patients Personal Satisfaction Pharmaceutical Preparations Physician Executives Physicians Population Process Process Measure Publishing Qualitative Methods Recording of previous events Recurrence Rehabilitation therapy Research Research Personnel Research Support Resources Risk Adjustment Site Skilled Nursing Facilities Structure System Testing Time Training Universities Veterans Work acute care base care outcomes care providers career career development community living cost cost effective design deviant disability experience functional loss functional outcomes functional status high risk hospital readmission hospital utilization implementation science improved improved outcome indexing innovation medication safety mortality multi-component intervention novel premature primary outcome public health relevance readmission rates secondary outcome

项目摘要

DESCRIPTION (provided by applicant): There is perhaps no more crucial time period for the health and functional outcomes of Veterans than an acute hospitalization followed by a stay in a post-acute care (PAC) facility (rehabilitatio or skilled nursing facility). The population of Veterans who undergo this transition are generally elderly, frail, ill, and disabled. As a result, many are sent back to the Emergency Department or readmitted to the hospital. This is often the start of a downward spiral of recurrent admissions, worsening functional status resulting in long-term care placement, and early mortality. For example, our preliminary data indicates Veterans discharged to PAC were readmitted or sent to the Emergency Department 5 times on average in the 12 months following their index admission. Transitions from the hospital to PAC are becoming more and more common, but poor outcomes may be preventable. In our preliminary data, we found nearly half of all readmissions from PAC facilities occurred in the first seven days after hospital discharge. Substantial research supports the idea that poorly-executed transitions of care from the hospital to the post-acute care facility underlie many poor outcomes of Veterans who undergo this transition. However, little is known about the outcomes of Veterans discharged to post-acute care, nor what factors contribute to these outcomes. To identify which factors might affect outcomes in these transitions of care, the proposal uses the Ideal Transitions of Care framework, developed by the nominee, to identify key domains that may affect transitional care outcomes. In this proposal, our Aims include: Aim 1: Assess the impact of five key domains of the ITC framework on 7-day hospital utilization and mortality. Domains and examples include: discharge planning (hospital plan for delivery of high-intensity interventions in PAC), information transfer (PAC access to hospital EMR), medication safety (medication reconciliation and monitoring of high-risk medications), advance care planning (addressing and communicating code status), and patient monitoring (time to initial PAC physician evaluation). Aim 2: Determine modifiable transitional care processes that help explain positive deviance in high-performing hospital-PAC sites. Aim 3: Pilot test a nurse-directed transitional care intervention in a hospital PAC site based on key domains of the ITC framework identified in Aims 1 and 2. This work is of crucial importance to Veterans and the VA healthcare system nationally and has the support of the Office of Geriatrics and Extended Care. Three accomplished investigators will guide the nominee's project work and development as an independent investigator. Dr. Michael Ho is the primary mentor with expertise in mixed methods, multicomponent interventions, and implementation science. He is the Co-Director of the Ischemic Heart Disease QUERI, Co-Director of the Denver-Seattle COIN, and a widely-published and well- funded expert in health outcomes research. Dr. Cari Levy is a co-mentor with significant content expertise relevant to the proposal, including experience with the main dataset used in the proposal, as a geriatrician and prior nursing home medical director, and as an accomplished researcher in the PAC setting. Dr. Allan Prochazka is a senior investigator with substantial Career Development Award mentorship experience as Director of Mentorship and Career Development at the Denver-Seattle COIN. Career development activities include gaining expertise in longitudinal and clustered data analysis, qualitative data methods, and implementation science. This will be facilitated by mentorship with two content experts (Dr. Jacqueline Jones, a qualitative expert, and Dr. Anna Baron, a statistical expert), coursework, and seminars taking advantage of the rich resources of the Denver-Seattle COIN and University of Colorado. The mentorship, training, and protected time afforded by this award will ensure the nominee's development as an independent investigator dedicated to improving transitions of care after hospital discharge throughout the VA system.

描述（由申请人提供）：退伍军人的健康和功能结果可能没有比急性住院的关键时期更重要的时间，然后住在急性后护理（PAC）设施（Rehabilitatio或熟练的护理设施）中。经历这种过渡的退伍军人人口通常是年龄较大的，脆弱的，生病的和残疾的。结果，许多人被送回急诊室或已回收给医院。这通常是反复入院的下降螺旋的开始，令人担忧的功能状态导致长期护理的放置和早期死亡。例如，我们的初步数据表明，在入院索引后的12个月内，已将送往PAC的退伍军人平均被送往急诊室或发送给急诊室。从医院到PAC的过渡变得越来越普遍，但是可能会预防差的不良结果。在我们的初步数据中，我们发现PAC设施的所有再入院中的几乎一半发生在住院后的前7天。大量研究支持这样的想法，即从医院到急性护理机构的护理过渡不佳，这是经历过这种过渡的退伍军人的许多不良结果。但是，对出院后护理的退伍军人的结果知之甚少，也不对这些因素造成这些结果的影响。为了确定哪些因素可能会影响这些护理过渡的结果，该提案使用了由提名人开发的理想护理框架过渡，以识别可能影响过渡性护理结果的关键领域。在此提案中，我们的目标包括：目标1：评估ITC框架五个关键领域对7天医院利用和死亡率的影响。域名和示例包括：出院计划（PAC中高强度干预措施的医院计划），信息转移（PAC访问医院EMR），药物安全（药物对帐和监测高风险药物），预先护理计划（解决方案和通信代码状态）以及患者监测（最初的PAC物理评估时间）。 AIM 2：确定可修改的过渡护理过程，有助于解释高性能医院PAC站点的积极偏差。 AIM 3：试点在医院测试护士指导的过渡护理干预措施 PAC网站基于目标1和2中确定的ITC框架的关键领域。这项工作对退伍军人和全国范围内的VA医疗保健系统至关重要，并得到了老年医学和扩展护理办公室的支持。三名成熟的调查人员将指导被提名人作为独立调查员的项目工作和发展。迈克尔·霍（Michael Ho）博士是混合方法，多组分干预措施和实施科学专家的主要导师。他是缺血性心脏病Queri的联合导演，Denver-Seactle Coin的联合导演，也是健康成果研究的广泛且资金丰富的专家。 Cari Levy博士是一位与该提案有关的重要内容专家的联合会所，包括在提案中使用的主要数据集的经验，作为老年医生和先前的护士家庭医疗总监，以及PAC环境中有成就的研究人员。 Allan Prochazka博士是一名高级调查员，在丹佛 - 斯特尔硬币担任指导和职业发展总监，拥有丰富的职业发展奖指导经验。职业发展活动包括获得纵向数据分析，定性数据方法和实施科学方面的专业知识。这将由指导与两位内容专家（定性专家Jacqueline Jones博士，统计专家Anna Baron博士），课程工作和下水道的Anna Baron博士一起准备，并利用了丹佛 - 席位硬币和科罗拉多大学的丰富资源。该奖项提供的心态，培训和受保护的时间将确保被提名人作为独立调查员的发展，致力于改善整个VA系统的住院后护理过渡。