Medication Intervention in Transitional Care to Optimize CKD Outcomes & Costs

过渡期护理中的药物干预可优化 CKD 结局

• 批准号: 8232548
• 负责人: Cindy Lou Corbett
• 金额: $ 31.34万
• 依托单位: SACRED HEART MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-30 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8232548
• 关键词: 21 year old; Accident and Emergency department; Acute; Adoption; Adult; Adverse event; Age; Agreement; Blinded; Blood Pressure; Caring; Cessation of life; Charge; Chronic; Chronic Disease; Chronic Kidney Failure; Clinical; Clinical Research; Clinical Trials Design; Clinical assessments; Cognitive; Comorbidity; Complex; Computational algorithm; Continuity of Patient Care; Cost Savings; Data; Diabetes Mellitus; Diagnosis; Dialysis procedure; Disease Management; Disease Outcome; Disease Progression; Economics; Effectiveness; Enzyme Inhibition; Family member; Focus Groups; General Population; Goals; Health; Health Care Costs; Health Professional; Healthcare Systems; Home environment; Hospitalization; Hospitals; Informed Consent; Institutional Review Boards; Intervention; Kidney Transplantation; Knowledge; Lead; Learning; Length of Stay; Logistic Regressions; Measures; Medication Management; Methods; Metric; Mission; Modeling; Myocardial Infarction; National Institute of Diabetes and Digestive and Kidney Diseases; Outcome; Outcome Measure; Outpatients; Participant; Patient Care; Patient Transfer; Patients; Peptidyl-Dipeptidase A; Pharmaceutical Preparations; Pharmacists; Pilot Projects; Population; Public Health; Qualitative Research; Randomized; Recommendation; Regimen; Regression Analysis; Research; Research Design; Research Personnel; Resolution; Risk; Risk Factors; Sampling; Self Management; Staging; Surveys; Survivors; System; Testing; Translating; Type 2 Angiotensin II Receptor; Visit; Work; Writing; base; blind; blood pressure regulation; clinically relevant; cost; disorder risk; evidence base; glycemic control; health literacy; high risk; hospital readmission; hypertension control; improved; innovation; medication compliance; novel strategies; prevent; primary outcome; sex

DESCRIPTION (provided by applicant): Project summary Transitional care interventions reduce hospital readmissions and slow the progression of declining health in the general population of hospitalized patients. What is not known is the impact transitional care interventions can have for the hospitalized CKD population. CKD patients are in critical need of improved transitional care that includes accurate and comprehensive medication information transfer. The main objective of this application is to pilot-test the effectiveness of a medication information transfer intervention to improve clinically-relevant outcomes in CKD. To this end, the following Specific Aims will be achieved: 1. Evaluate the impact of transitional care interventions on acute care utilization following hospital discharge among patients with CKD. 2. Evaluate the impact of transitional care strategies on management of CKD risk factors and complications. Focus groups will first be conducted to assure relevance and to refine the intervention. A qualitative research design with convenience sampling will be used to survey recently hospitalized CKD patients (n~10) and their healthcare professionals (n~10). The medication information transfer intervention will be evaluated in a pilot study using a randomized, single-blind clinical trial design. Participants and the pharmacist interventionist will have knowledge of group assignment, but the other investigators and research staff will be blinded. Study entry criteria will include hospitalized patients >21 years old (n=120) who have a diagnosis of CKD stages 3-5 (not including those treated by dialysis or kidney transplant). After obtaining IRB-approved written informed consent, patients will be randomized by computer algorithm for group assignment, stratifying according to diabetes status. The pharmacist will visit participants in the home within 5 days of hospital discharge. The 5As (Assessment, Advice, Agreement, Assistance, and Arrangements) Self-Management Model will be used to implement the medication information transfer intervention. Clinical assessments will be performed at baseline and at 30 and 90 days. Primary outcome measures for Specific Aim 1 will be acute care utilization (emergency department visits and hospitalizations). The main outcomes for Specific Aim 2 will be measures of CKD risk factors and complications. Blood pressure will be the primary outcome for this aim because hypertension control is the most consistent recommendation for slowing CKD progression. Logistic regression analyses will be employed controlling for age, sex, CKD stage, co- morbidities, Charleson score, cognitive status, medication adherence and health literacy. Cost will be analyzed based on charges from hospitalization through the following 90 days using a difference-of- difference approach. This contribution is significant because it will define methods to overcome system barriers that result in impaired quality and continuity of care. The proposed research is innovative because it integrates established clinical strategies with systems approaches to improve patient care, thereby testing a fundamentally new approach to advance CKD management. PUBLIC HEALTH RELEVANCE: Project narrative the proposed research is relevant to public health because it will positively impact a common, deadly, and costly chronic disease - CKD - by reducing acute care utilization and costs as well as by improving outpatient management. This medication information transfer intervention in the transitional care of hospitalized CKD patients will have wide-appeal for adoption by healthcare systems and for other chronic illnesses. The project supports the mission of NIDDK by translating lessons learned from clinical research in CKD into improved clinical outcomes that can be readily measured and anticipated in practice.

描述（由申请人提供）：项目摘要过渡护理干预措施减少了医院的再入院，并减缓了住院患者一般人群健康状况下降的进展。尚不清楚的是过渡护理干预措施可能对住院的CKD人群产生影响。 CKD患者迫切需要改善过渡护理，包括准确，全面的药物信息转移。该应用程序的主要目的是试验药物的有效性 信息转移干预措施以改善CKD中与临床相关的结果。为此，将实现以下具体目标：1。评估过渡护理干预措施的影响 CKD患者出院后出院后的急性护理利用。 2。评估过渡护理策略对CKD风险因素和并发症的管理的影响。焦点小组将首先进行以​​确保相关性并完善干预措施。具有方便抽样的定性研究设计将用于调查最近住院的CKD患者（N〜10）及其医疗保健专业人员（N〜10）。药物信息转移干预措施将在试点研究中使用随机的单盲临床试验设计进行评估。参与者和药剂师干预主义者将了解 小组分配，但其他调查人员和研究人员将被视而不见。研究进入标准将包括诊断为CKD阶段3-5的21岁（n = 120）的住院患者（不包括受透析或肾脏移植治疗的患者）。在获得IRB批准的书面知情同意书后，患者将通过计算机算法随机分组以进行小组分配，并根据糖尿病状态进行分层。药剂师将拜访参与者 住院后5天内回家。 5A（评估，建议，协议，援助和安排）将使用自我管理模型来实施药物信息转移干预措施。临床评估将在基线和30和90天进行。特定目标1的主要结果指标将是急性护理利用（急诊就诊和住院）。特定目标2的主要结果将是衡量CKD风险因素和并发症。血压将是此目标的主要结果，因为高血压控制是减慢CKD进展的最一致的建议。逻辑回归分析将用于控制年龄，性别，CKD阶段，共同病毒，Charleson评分，认知状况，药物依从性和健康素养。使用差异方法，将根据住院到接下来的90天的费用来分析成本。这项贡献很重要，因为它将定义克服系统障碍的方法，从而导致护理的质量和连续性受损。拟议的研究具有创新性，因为它将既定的临床策略与改善患者护理的系统方法相结合，从而测试了一种从根本上进行推进CKD管理的新方法。 公共卫生相关性：项目叙述拟议的研究与公共卫生有关，因为它将通过降低急性护理利用率和成本以及改善门诊管理来对公共健康造成积极影响，致命且昂贵的慢性病 - CKD。这种药物信息转移干预在住院的CKD患者的过渡护理中，将受到医疗保健系统和其他慢性疾病的采用。该项目通过将从CKD的临床研究中学到的经验教训为改进的临床结果来支持NIDDK的使命，这些临床结果可以很容易地在实践中进行测量和预期。