A Nurse-Led Physician-Directed System for Providing Optimal Cardiac Care

护士主导、医生指导的系统，可提供最佳的心脏护理

• 批准号: 7941674
• 负责人: Thomas Erling Kottke
• 金额: $ 41.73万
• 依托单位: HEALTHPARTNERS INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-20 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7941674
• 关键词: Accounting; Adoption; Adult; Affect; Aspirin; Businesses; Cardiac; Cardiology; Caring; Cessation of life; Client satisfaction; Clinic; Communication; Consultations; Control Groups; Coronary heart disease; Data; Development; Diabetes Mellitus; Diffusion; Discipline of Nursing; Exclusion Criteria; Exposure to; Failure; Goals; Intervention; Investments; Knowledge; Low-Density Lipoproteins; Measurable; Measures; Medical; Medicine; Nurses; Nursing Staff; Office Nursing; Outcome; Outcome Study; Patient Care; Patient Monitoring; Patients; Physicians; Preventive Intervention; Primary Care Physician; Primary Health Care; Private Practice; Problem Solving; Process; Provider; Relative (related person); Research; Research Design; Role; Secondary Prevention; Services; Site; Surveys; System; Testing; Tobacco use; Visit; Voice; Wisconsin; Work; aged; care delivery; care systems; cost; design; evidence base; evidence based guidelines; experience; improved; meetings; operation; post intervention; primary outcome; programs; public health relevance; satisfaction

DESCRIPTION (provided by applicant): A Nurse-Led Physician-Directed System for Providing Optimal Cardiac Care Despite efficacious secondary prevention interventions for coronary heart disease (CHD) and recognizing care delivery organization importance, CHD patients are not adequately identified and treated. The overall goal of this proposal is to test the hypothesis that the proportion of CHD patients meeting optimal cardiac care (OCC) criteria will increase in a multi-site primary care (PC) practice in association with implementation of a nurse-led physician-directed system that provides optimal cardiac care (NLPD-OCC). The specific aims are to evaluate 1) if exposure to NLPD-OCC increases the proportion of CHD patients meeting OCC criteria relative to optimal care of patients with a comparator condition, 2) the potential business case for system investment, 3) patient and physician/nurse satisfaction with NLPD-OCC, 4) clinic process adaptations with OCC. The study design is a non-equivalent control group design in which NLPD-OCC is implemented in 5 PC clinics and compared to optimal care outcomes for patients in a diabetes mellitus care program in the same medical practice. The intervention is a nurse-led physician-directed care management system for optimal care of CHD patients. Nurses identify the patients; ascertain if care is optimal; if not, initiate steps to achieve it, working with the patient's PC physician. Principles directing nursing activities include using evidence-based guidelines for patient care, coordination and communication among patients, providers and care sites; physician consultation; proactive patient monitoring between visits; anticipating patient and provider needs; encouraging patient's active involvement in their care; and problem solving. Subjects will be adults aged 40 or older, CHD patients of a PC physician in a Wisconsin medical practice. All CHD patients, less those meeting minimal exclusion criteria, receive the intervention. The primary outcomes of the study are OCC criteria of LDL level, BP level, tobacco use and aspirin use in CHD patients. Data will be obtained from patient chart review. We will examine the business case for the cardiac care management system by comparing investment costs of the system to changes in medical utilization and billing. Satisfaction levels of physicians, nurses and patients will be surveyed pre and post intervention. Adjustments to clinic roles and processes will be described qualitatively. PUBLIC HEALTH RELEVANCE: The treatment for patients who have coronary heart disease is well-defined. However, many patients get only some but not all of these treatments. Systems that are put in place in medical care settings help more patients get treated fully. This study will evaluate whether a system that uses a nurse to help provide that care will result in more patients getting more complete treatment. .

描述（由申请人提供）：用于提供最佳心脏护理的护士主导的医生指导系统尽管对冠心病（CHD）采取了有效的二级预防干预措施并认识到护理服务组织的重要性，但冠心病患者仍未得到充分的识别和治疗。该提案的总体目标是检验以下假设：在多站点初级保健 (PC) 实践中，与实施护士主导的医生指导相关的方法，满足最佳心脏护理 (OCC) 标准的 CHD 患者比例将会增加提供最佳心脏护理的系统（NLPD-OCC）。具体目标是评估 1) 相对于具有比较条件的患者的最佳护理，暴露于 NLPD-OCC 是否会增加满足 OCC 标准的 CHD 患者比例，2) 系统投资的潜在商业案例，3) 患者和医生/护士对 NLPD-OCC 的满意度，4) OCC 的临床流程调整。该研究设计是非等效对照组设计，其中 NLPD-OCC 在 5 个 PC 诊所实施，并与相同医疗实践中糖尿病护理计划中患者的最佳护理结果进行比较。该干预措施是一个由护士主导、医生指导的护理管理系统，旨在为先心病患者提供最佳护理。护士识别病人；确定护理是否最佳；如果没有，请与患者的 PC 医生合作，采取措施实现这一目标。指导护理活动的原则包括使用基于证据的患者护理指南，以及患者、提供者和护理场所之间的协调和沟通；医生咨询；就诊期间主动进行患者监测；预测患者和提供者的需求；鼓励患者积极参与护理；和解决问题。 受试者是 40 岁或以上的成年人、威斯康星州医疗机构 PC 医生的 CHD 患者。除符合最低排除标准的患者外，所有先心病患者均接受干预。该研究的主要结果是 CHD 患者中 LDL 水平、血压水平、烟草使用和阿司匹林使用的 OCC 标准。数据将从患者图表审查中获得。 我们将通过比较系统的投资成本与医疗利用率和计费的变化来研究心脏护理管理系统的业务案例。将在干预前后对医生、护士和患者的满意度进行调查。将定性地描述对诊所角色和流程的调整。 公共卫生相关性：冠心病患者的治疗方法是明确的。然而，许多患者只接受部分治疗，而不是全部治疗。医疗机构中建立的系统可帮助更多患者得到充分治疗。这项研究将评估使用护士帮助提供护理的系统是否会让更多患者获得更完整的治疗。 。