TELE-TOC: Telehealth Education Leveraging Electronic Transitions Of Care for COPD Patients - Resubmission - 1

TELE-TOC：利用电子转换护理慢性阻塞性肺病患者的远程医疗教育 - 重新提交 - 1

• 批准号: 10293492
• 负责人: Joanna Abraham
• 金额: $ 40万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-10 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10293492
• 关键词: TELE; TOC; Telehealth; Education; Leveraging

PROJECT ABSTRACT Transitions of Care (TOC) for high-risk, frequently hospitalized adults with chronic diseases are complex, costly, and vulnerable to safety threats and poor health outcomes. Communication breakdowns, information lapses, and IT-induced unintended consequences can result in poor follow-up and medication non-adherence, both of which contribute to preventable readmissions or emergency room (ER) visits. The Transitional Care Model (TCM) aims to reduce such risks through a holistic, collaborative, patient-centered approach with in-home interventions. Prior to the SARS-CoV-2 pandemic and resulting coronavirus disease 2019 (COVID-19), most in- home interventions relied on in-person visits, which can be cost-prohibitive and unsustainable. One potential sustainable and scalable solution is to use telehealth for in-home virtual visits; however, use of telehealth for post-discharge TOC interventions has not been routinely implemented. In the post-COVID-19 era, given the rapid expansion of telehealth, hospitals are well-positioned to initiate this virtual care. In-home virtual visits may be particularly promising for patients with chronic obstructive pulmonary disease (COPD), who are often hospitalized, have multiple comorbidities, and require intensive medication teaching due to rampant inhaler misuse. COPD affects more than 16 million US adults, many of whom are older, contribute ~$50 billion to healthcare costs annually, experience high rates of acute care revisits, often due to care coordination failures. For this reason, Medicare’s Hospital Readmission Reduction Program (HRRP) aims to incentivize hospitals to implement TOC programs for increased quality and value of care for COPD patients. However, currently, such programs fall short of aligning with the full TCM. In-home interventions may be particularly salient for improving medication skills and outcomes for patients with COPD given rampant inhaler misuses, the effectiveness of in- hospital inhaler education, and evidence showing the need for inhaler education reinforcement post discharge. Thus, our trans-disciplinary team proposes to implement and evaluate “TELE-TOC: Telehealth Education: Leveraging Electronic Transitions Of Care for COPD patients,” which seeks to integrate virtual, pharmacy-based, in-home visits for COPD patients within our hospital’s existing COPD HRRP. Our central hypotheses are that virtual visits with pharmacists will be feasible to implement and will result in improved medication use and outcomes among COPD patients at high risk for readmission. We aim to iteratively design TELE-TOC using participatory study design and stakeholder input. We will then test the effectiveness of adding TELE-TOC virtual visits in a randomized controlled trial among COPD patients enrolled in our HRRP program. Lastly, we will develop a plan for a dissemination strategy and roadmap with national stakeholders to facilitate widescale adoption of TELE-TOC nationwide.

项目摘要 高风险，经常住院的患有慢性疾病的成年人的护理过渡（TOC）复杂，昂贵， 容易受到安全威胁和健康状况不佳的影响。沟通分解，信息失误， IT引起的意外后果可能导致随访和药物不遵守，这两种 这有助于可预防的再入院或急诊室（ER）访问。过渡护理模型 （TCM）旨在通过整体，协作，以患者为中心的方法来降低此类风险 干预措施。在2019年SARS-COV-2大流行和导致的冠状病毒疾病之前（Covid-19） 家庭干预依赖于面对面的访问，这可能是良性的和不可持续的。一个潜力 可持续和可扩展的解决方案是将远程医疗用于家庭虚拟访问；但是，将远程医疗用于 病后TOC干预措施尚未常规实施。在后期19时代，鉴于 远程医疗的快速扩展，医院良好地启动了这种虚拟护理。在家虚拟访问可能 对于患有慢性阻塞性肺疾病（COPD）的患者而言，这是特别有前途的 住院，有多种合并症，并且由于吸入器猖ramp而需要大量的药物教学 滥用。 COPD影响超过1600万的美国成年人，其中许多年龄较大，贡献了约500亿美元 医疗保健费用每年每年经历高急性护理率，通常是由于护理协调失败所致。 因此，Medicare的医院减排计划（HRRP）旨在激励医院 实施TOC计划，以提高COPD患者的护理质量和价值。但是，目前，这样的 程序与完整的TCM不符。内部干预措施可能特别重要 患有COPD患者的药物技能和结局猖ramm 医院吸入器教育以及表明出院后需要吸入教育增强的证据。 这，我们的跨学科团队提议实施和评估“ Tele-Toc：Telethealth教育： 为COPD患者提供护理的电子过渡，“旨在整合虚拟的基于药房的， 我们医院现有的COPD HRRP中的COPD患者的家庭访问。我们的中心假设是 与药剂师进行的虚拟访问将是可行的，并且会改善用药的使用和 COPD患者的结果高风险。我们旨在使用迭代设计tele-toc使用 参与研究设计和利益相关者的投入。然后，我们将测试添加Tele-Toc Virtual的有效性 参加我们HRRP计划的COPD患者的随机对照试验访问。最后，我们会的 制定与国家利益相关者制定传播策略和路线图的计划，以促进广泛 在全国范围内采用Tele-Toc。