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

基本信息

批准号：
8338869
负责人：
Cindy Lou Corbett
金额：
$ 30.79万
依托单位：
SACRED HEART MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-09-30 至 2014-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8338869
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

项目摘要

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.

描述（由申请人提供）：项目摘要过渡性护理干预措施可减少住院患者的再入院率并减缓健康状况恶化的进程。目前尚不清楚过渡性护理干预措施对住院 CKD 人群的影响。 CKD 患者迫切需要改进的过渡护理，包括准确和全面的药物信息传输。该应用程序的主要目的是试点测试药物的有效性信息传输干预可改善 CKD 的临床相关结果。为此，将实现以下具体目标： 1. 评估过渡性护理干预措施的影响 CKD 患者出院后的急性护理利用情况。 2. 评估过渡护理策略对 CKD 危险因素和并发症管理的影响。首先将进行焦点小组讨论，以确保相关性并完善干预措施。将采用方便抽样的定性研究设计来调查最近住院的 CKD 患者 (n~10) 及其医疗保健专业人员 (n~10)。将使用随机、单盲临床试验设计在试点研究中评估药物信息传递干预措施。参与者和药剂师干预师将了解小组分配，但其他调查员和研究人员将被蒙蔽。研究纳入标准将包括年龄 >21 岁 (n=120) 且诊断为 CKD 3-5 期的住院患者（不包括接受透析或肾移植治疗的患者）。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，并根据糖尿病状况进行分层。药剂师将拜访参与者出院后 5 天内回家。将采用5A（评估、建议、协议、协助和安排）自我管理模型来实施用药信息传递干预。临床评估将在基线以及 30 天和 90 天时进行。具体目标 1 的主要结果指标是急症护理的利用（急诊科就诊和住院治疗）。具体目标 2 的主要成果是衡量 CKD 危险因素和并发症。血压将是这一目标的主要结果，因为控制高血压是减缓 CKD 进展的最一致的建议。将采用逻辑回归分析来控制年龄、性别、CKD 分期、合并症、Charleson 评分、认知状态、药物依从性和健康素养。将根据接下来 90 天的住院费用，采用差异法进行分析。这一贡献意义重大，因为它将定义克服导致护理质量和连续性受损的系统障碍的方法。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，从而测试了一种推进 CKD 管理的全新方法。

项目成果

期刊论文数量（3）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Medication Therapy Management after Hospitalization in CKD: A Randomized Clinical Trial.

CKD 住院后的药物治疗管理：随机临床试验。

DOI：
10.2215/cjn.06790617
发表时间：
2018
期刊：
Clinical journal of the American Society of Nephrology : CJASN
影响因子：
0
作者：
Tuttle,KatherineR;Alicic,RadicaZ;Short,RobertA;Neumiller,JoshuaJ;Gates,BrianJ;Daratha,KennB;Barbosa-Leiker,Celestina;McPherson,SterlingM;Chaytor,NaomiS;Dieter,BradP;Setter,StephenM;Corbett,CynthiaF
通讯作者：
Corbett,CynthiaF