Developing technology-based approaches to improve access and quality of care in cirrhosis

开发基于技术的方法来改善肝硬化护理的可及性和质量

基本信息

批准号：
10360519
负责人：
Marina Serper
金额：
$ 19.06万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-04-01 至 2023-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10360519
关键词：
Address Adherence Adoption Adrenergic beta-Antagonists Affect Antiviral Agents Area Award Behavior Therapy Caring Characteristics Chronic Disease Chronic Obstructive Pulmonary Disease Cirrhosis Clinical Clinical Trials Clinical Trials Design Communities Community Hospitals Complement Complex Congestive Heart Failure Data Databases Faculty Feedback Funding Future Gastroenterologist General Hospitals Goals Grant Guidelines HIV Health Care Costs Health Services Accessibility Health Technology Health system Healthcare Hemorrhage Hepatitis A Hepatitis C Hepatitis C Therapy Hepatology Hospital Mortality Hospitalization Hospitals Improve Access Individual Information Technology Inpatients Intervention Interview Knowledge Liver Liver Cirrhosis Liver diseases Malignant neoplasm of liver Medical center Medicine Mentors Mentorship Methods Mississippi Observational Study Outcome Outcomes and Health Services Research Patient Care Patients Pennsylvania Prevalence Prevention Primary Health Care Primary carcinoma of the liver cells Problem-Based Learning Process Provider Quality Indicator Quality of Care Research Research Personnel Sample Size Site Source Specialist Structure Symptoms Technology Testing Time Training Transplantation United States United States National Institutes of Health Universities Vaccination Varicosity Veterans Voice Work acceptability and feasibility base care burden care delivery career career development chronic liver disease clinical practice cohort cost design evidence base experience gaps in access gastrointestinal geographically distant health care delivery health care service utilization hospital readmission implementation science improved innovation medical specialties mortality patient oriented research pilot test professor programs targeted delivery telehealth tertiary care therapy design

项目摘要

PROJECT SUMMARY Liver cirrhosis affects greater than 5 million individuals in the United States. Recent national data show a 59% increase in cirrhosis prevalence and a 52% increase in cirrhosis mortality from 2001-2013. Despite effective hepatitis C (HCV) eradication with new direct-acting antivirals, the burden of chronic liver disease and hepatocellular carcinoma will continue to rise, resulting in up to $10.6 billion in annual health care costs. Cirrhosis management is highly complex and requires specialized training, however, due to workforce shortages, 82% of cirrhosis-related hospitalizations occur at non-transplant hospitals and only 45% of cirrhotic patients see a gastroenterologist or hepatologist within one year of hospitalization. Overcoming barriers to access to specialty care may be feasible with telehealth, which has shown promise in HCV treatment, HIV, and other chronic diseases, however, this approach has not been rigorously investigated in cirrhosis. The proposed research fills gaps in cirrhosis care management through the following innovations: 1) identifying modifiable barriers to high quality cirrhosis care using the largest, multi-center database to date; 2) tailoring a telehealth program specific to cirrhosis using implementation science principles for rapid adoption into clinical practice; and 3) delivering a telehealth intervention to geographically distant and diverse sites. The hypothesis that telehealth may improve the access and quality of care in cirrhosis will be pursued through the following interrelated Specific Aims: (1) investigate how access to specialty care impacts process of care and clinical outcomes among a national VA cohort, (2) conduct qualitative interviews to explore barriers and facilitators of access to care and potential uses for telehealth among clinicians at low and high specialty-care- access sites, and (3) pilot-test a telehealth intervention to provide timely hepatology care to patients with cirrhosis complications at two community hospitals, and enhance non-expert provider training through problem- based learning. The project aims will identify modifiable factors to improve the delivery of high-quality care for cirrhosis and establish the feasibility of a telehealth strategy to increase access to specialty care. The PI is Assistant Professor of Medicine, a hepatologist, and hypothesis-driven clinical researcher at the University of Pennsylvania. Her experience in patient-oriented and observational research and a Master's in Health Services and Outcomes Research have prepared her to execute the project aims. The proposed research will be combined with carefully structured mentorship by faculty with complementary expertise, institutional support, and coursework in advanced observational methods, clinical trials, information technology, and implementation science. This award and protected time will allow the applicant to build an independent NIH-funded research career and become a leader in technology-based approaches to improve care delivery in chronic liver disease, an area that is lacking to date, and with potential applications to other chronic diseases.

项目摘要在美国，肝肝硬化会影响超过500万人。最近的国家数据显示59％从2001 - 2013年开始，肝硬化患病率的增加和肝硬化死亡率增加了52％。尽管有效乙型肝炎（HCV）消除具有新的直接作用抗病毒药，慢性肝病和肝细胞癌将继续上升，最高为106亿美元的年度医疗费用。肝硬化管理非常复杂，需要专门的培训，但由于劳动力短缺，有82％的肝硬化相关住院发生在非移植医院，只有45％患者在住院后的一年内见到胃肠病学家或肝医生。克服障碍远程医疗可能可行地获得专业护理，这在HCV治疗，艾滋病毒和然而，其他慢性疾病尚未在肝硬化中进行严格研究。拟议的研究通过以下创新填补了肝硬化护理管理的空白：1）使用迄今为止最大的多中心数据库来识别高质量肝硬化护理的可修改障碍； 2）使用实施科学原则来量身定制针对肝硬化的远程医疗计划，以快速采用进入临床实践； 3）将远程医疗干预提供给地理上遥远和多样化的地点。这假设远程医疗可能会改善肝硬化的访问和质量以下相关的具体目的：（1）调查获得专业护理的访问如何影响护理过程和国家弗吉尼亚州队列中的临床结果，（2）进行定性访谈以探索障碍和低和高专业护理的临床医生，远程医疗医生获得护理和潜在用途的促进者访问网站和（3）试验远程医疗干预措施，以及时为患者提供肝病护理两家社区医院的肝硬化并发症，并通过问题增强非专业提供者培训 - 基于学习。该项目的目的将确定可修改的因素以改善高质量护理的交付肝硬化并建立远程医疗策略的可行性，以增加获得专业护理的机会。 PI是医学助理教授，肝病学家，也是假设驱动的临床研究人员宾夕法尼亚大学。她在以患者为导向和观察性研究的经验和大师的经验在卫生服务和成果方面，研究使她为执行该项目的目标做好了准备。提议研究将与教师精心结构的指导结合在一起，并具有互补的专业知识，高级观察方法，临床试验，信息技术的机构支持和课程和实施科学。该奖项和受保护的时间将使申请人能够建立独立 NIH资助的研究职业，并成为基于技术的方法的领导者，以改善医疗服务慢性肝病，这是迄今为止缺乏的区域，并且可能应用于其他慢性疾病。