The Virtual Mentored Implementation to Reduce REVISITS (Reducing Respiratory Emergent Visits using Implementation Science Interventions Tailored to Setting) Study

减少复诊的虚拟指导实施（使用针对环境量身定制的实施科学干预措施减少呼吸系统急诊就诊）研究

• 批准号: 10171894
• 负责人: Valerie G Press
• 金额: $ 78.67万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10171894
• 关键词: Accident and Emergency department; Address; Adoption; Adult; Affect; American; Caring; Chest; Chicago; Chronic Obstructive Airway Disease; Clinical; Cohort Studies; Communication; Consolidated Framework for Implementation Research; Continuity of Patient Care; Cost Savings; Data; Education; Educational workshop; Effectiveness; Effectiveness of Interventions; Emergency department visit; Enrollment; Evaluation; Evidence based intervention; Evidence based program; Failure; Glean; Goals; Health system; Healthcare; Hospital Societies; Hospitalization; Hospitals; Hybrids; Incentives; Individual; Intervention; Lead; Leadership; Long-Term Care; Mediator of activation protein; Medicare; Medicine; Mentors; Methods; Modeling; National Heart, Lung, and Blood Institute; Outcome; Participant; Patient Care; Patients; Penetration; Persons; Pharmaceutical Preparations; Policies; Program Effectiveness; Program Sustainability; Public Health; Publishing; Randomized; Recurrence; Reporting; Resources; Self Management; Site; Site Visit; Societies; Training; Universities; Variant; Visit; acute care; base; burden of illness; cohort; comparative effectiveness; compare effectiveness; effectiveness evaluation; effectiveness implementation design; effectiveness implementation study; evidence base; experience; hospital readmission; implementation outcomes; implementation science; implementation strategy; improved; innovation; intervention program; mortality; program costs; programs; pulmonary function decline; respiratory; self-management program; virtual; virtual intervention; virtual visit

PROJECT SUMMARY Chronic Obstructive Pulmonary Disease (COPD) affects 16 million US adults, many of whom experience high rates of emergency department and hospital COPD revisits after initial hospitalizations due to care transition failures. These frequent COPD exacerbations lead to more rapid lung function decline and earlier mortality. Further, hospitalizations for exacerbations highly contribute to the ~$50 billion spent annually for COPD care in the US. Therefore, COPD revisits are now a public health crisis. It is feasible to improve COPD care and decrease acute care revisits, as shown by published evidence of successful care transition interventions. Our team has led efforts to identify effective care transition interventions and has successfully piloted a multi-level COPD care transition program. Effective care transition interventions include medication reconciliation, self- management education, and post-discharge communication. However, for wide-spread adoption to occur, we must identify optimal intervention delivery methods based on hospitals' resources and patient care needs. For instance, virtually-supported interventions are often more resource-friendly, and while effectiveness data on individual virtual interventions exists, multi-level virtual programs have not yet been studied compared to in- person programs. In addition, feasible implementation approaches to support the delivery of evidence-based care transition programs are needed for wide-scaled dissemination and sustainability. Our team has found that a mentored implementation model is effective for implementing multi-level, hospital-based programs across US health systems. This approach traditionally relies on in-person site visits. The use of virtual site visits could dramatically increase this model's reach, but has not yet been studied. In summary, for successful, wide-scale adoption, diverse US hospitals need to have access to feasible, multi-level care transition programs and effective implementation approaches that are aligned with site-specific care needs and resources, but currently the optimal approach is unknown. Thus, in this proposal, we will compare the effectiveness of virtual vs. in- person multi-level COPD care transition programs in real-world settings by concurrently studying whether virtual or in-person mentored implementation increases programs' reach. We will collaborate with the Hospital Medicine Reengineering Network convened for rapid discovery and dissemination to identify and enroll sites. After conducting pre-implementation contextual assessments at all sites using the Consolidated Framework for Implementation Research, we will conduct a Hybrid Type II Effectiveness-Implementation study to determine effectiveness of the programs to reduce 30-day COPD revisits and of the mentored implementation to increase program penetration. Finally, we will study programs' sustained outcomes for two years post-implementation. Data from this study will inform the optimal implementation of COPD care transition programs at scale. Further, lessons gleaned from this study can inform implementation approaches for other hospital-based programs.

项目概要 慢性阻塞性肺疾病 (COPD) 影响着 1600 万美国成年人，其中许多人患有高血压 由于护理转换而初次住院后，急诊科和医院慢性阻塞性肺病 (COPD) 再次就诊的比率 失败。这些频繁的慢性阻塞性肺病恶化导致肺功能更快下降和更早死亡。 此外，每年因病情加重而住院治疗的 COPD 护理费用约 500 亿美元 美国。因此，慢性阻塞性肺病的复诊现在已成为一场公共卫生危机。改善 COPD 护理是可行的 已发表的成功护理过渡干预措施的证据表明，减少急性护理重访。我们的 团队领导努力确定有效的护理过渡干预措施，并成功试点了多层次的 慢性阻塞性肺病护理过渡计划。有效的护理过渡干预措施包括药物协调、自我护理 管理教育和出院后沟通。然而，为了广泛采用，我们 必须根据医院的资源和患者护理需求确定最佳的干预实施方法。为了 例如，虚拟支持的干预措施通常更加资源友好，而且虽然有效性数据 个人虚拟干预措施是存在的，但与内部虚拟项目相比，尚未对多层次虚拟项目进行研究。 人计划。此外，支持提供基于证据的可行实施方法 护理过渡计划需要广泛传播和可持续性。我们的团队发现 指导实施模式对于在美国各地实施多层次、以医院为基础的计划非常有效 卫生系统。这种方法传统上依赖于亲自现场访问。使用虚拟站点访问可以 极大地增加了该模型的影响范围，但尚未进行研究。总之，要成功、大规模 采用，不同的美国医院需要获得可行的、多层次的护理过渡计划和 与特定地点的护理需求和资源相一致的有效实施方法，但目前 最佳方法未知。因此，在本提案中，我们将比较虚拟与内部的有效性 通过同时研究是否 虚拟或面对面的指导实施可以扩大项目的影响范围。我们将与医院合作 药物再工程网络召开，旨在快速发现和传播，以确定和注册站点。 使用统一框架在所有地点进行实施前背景评估后 实施研究，我们将进行 II 类有效性与实施混合研究，以确定 减少慢性阻塞性肺病 30 天复诊的计划的有效性以及增加指导实施的有效性 程序渗透。最后，我们将研究项目实施后两年的持续成果。 这项研究的数据将为大规模慢性阻塞性肺病护理过渡计划的最佳实施提供信息。更远， 从这项研究中收集的经验教训可以为其他医院项目的实施方法提供参考。