Improving Quality of Care in Parkinsons Disease: A Randomized Controlled Trial

提高帕金森病的护理质量：随机对照试验

• 批准号: 8204044
• 负责人: Karen Ilene Connor
• 金额: --
• 依托单位: VA GREATER LOS ANGELES HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-05-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8204044
• 关键词: Address; Adherence; Administrator; Adoption; Advisory Committees; Advocacy; Advocate; Affect; Autonomic nervous system; Benchmarking; Bradykinesia; Brain Diseases; California; Care given by nurses; Caring; Case Manager; Chronic; Clinical; Clinical Protocols; Collaborations; Communication; Communities; Consensus; Cost Analysis; Data; Data Collection; Dementia; Development; Diagnosis; Dimensions; Discipline; Education; Enrollment; Evaluation; Evidence based treatment; Family; Functional disorder; Funding; Future; Geographic Locations; Goals; Guidelines; Health; Health Care Costs; Health Personnel; Health Promotion; Health Services Research; Health Status; Healthcare; Healthcare Systems; Impaired cognition; Impairment; Information Systems; Intervention; Interview; Investigation; Knowledge; Lead; Leadership; Los Angeles; Measures; Medical Records; Mental Depression; Mentorship; Methods; Modeling; Moods; Motor; Motor Manifestations; Movement Disorders; Neurodegenerative Disorders; Nevada; Nurses; Outcome; Outcome Measure; Outcome Study; Parkinson Disease; Participant; Patients; Perception; Persons; Physicians; Pilot Projects; Policies; Positioning Attribute; Practice Guidelines; Process; Process Measure; Protocols documentation; Provider; Psyche structure; Qualitative Evaluations; Quality Indicator; Quality of Care; Quality of life; Randomized; Randomized Controlled Trials; Recruitment Activity; Relative (related person); Research; Research Personnel; Resources; Role; Self Efficacy; Series; Site; Sleep; Sleep Disorders; Societies; Specialist; Structure; Surveys; Symptoms; System; Telephone; Telephone Interviews; Testing; Time; Translating; Translations; Tremor; United States Department of Veterans Affairs; Variant; Veterans; abstracting; arm; base; care delivery; chronic care model; coping; cost; design; dissemination research; empowered; evidence base; evidence based guidelines; experience; falls; follow-up; health care service utilization; health related quality of life; improved; intervention program; meetings; member; motor impairment; nervous system disorder; prevent; programs; research study; secondary outcome; social; tool; treatment as usual

DESCRIPTION (provided by applicant): Over 40,000 Veterans across VHA are diagnosed with Parkinson's disease (PD), a chronic, debilitating neurodegenerative disease that produces more symptoms over time, affects motor abilities, and has a wide range of non-motor dysfunctions including sleep disorders, depression, and cognitive impairment that broadly impact physical, mental, and social dimensions of health-related quality of life. The ultimate goal of this proposed study is to test whether a nurse-led, coordinated care management intervention improves the quality of care and health status for veterans with PD, and to determine its cost and the feasibility of its implementation. Six Parkinson's Disease Research, Education, and Clinical Centers (PADRECC) were established a decade ago to provide subspecialty care within VA for PD and other movement disorders, but there are inadequate numbers of subspecialists to provide care to all veterans with PD. To address this problem, a series of investigations have been conducted following the VA Quality Enhancement Research Initiative (QUERI) process to 1) develop a comprehensive set of evidence-based indicators to measure the quality of PD care, 2) identify and document gaps in VA care relative to these indicators, and 3) analyze variations in PD care quality and factors associated with those variations. Based on this research, a delivery system redesign - with nurse care managers, using standardized assessment tools and care coordination protocols to address unmet needs of Veterans with PD, and collaborating with these Veterans and their families, providers, and community partners to manage PD care - is hypothesized to overcome identified barriers to the translation of evidence-based guidelines for PD care into general VA care delivery systems. In a nearly-completed pilot study funded by VA, a Task Force of stakeholders that includes nurses, physicians, other healthcare disciplines, and patient advocates was established; Task Force members were drawn from a network of VA facilities in VISN 22 (southern California and Nevada) that are affiliated with the PADRECC at the VA Greater Los Angeles Healthcare System, and from PD advocacy groups. The Task Force achieved consensus on a broad range of quality goals for benchmarking the quality of PD care in this VISN, goals that were selected based on the previously developed evidence-based quality indicators for PD care and on prior research documenting gaps in care. These targeted quality goals in turn guided the development, pilot-testing among veterans with PD, and subsequent refinement of a set of care management tools and detailed clinical protocols necessary for implementing the nurse-led, coordinated care intervention. In this proposed study, this new care model will be put in place at three VISN 22 VA facilities engaged in the pilot study and will involve clinical champions for PD care from the Task Force. Four hundred veterans with PD from those facilities will then be enrolled and randomized in a 1:1 ratio to either this new, coordinated care model or to usual care. Veterans will be assessed at baseline and at three follow-ups through 18 months. Primary study outcomes are adherence to the identified quality goals; secondary study outcomes will include health-related quality of life, perceptions of care quality, and self-efficacy. Veterans will be surveyed by telephone and medical records will be abstracted to measure these outcomes. A cost analysis will be conducted to summarize program costs to VA, and to examine whether there is a cost offset between randomization arms. A qualitative evaluation of the extent of implementation of the intervention, as well as barriers and facilitators to potential dissemination, will also be conducted. These data will provide new knowledge vital to future dissemination across VA of this intervention, if it is found to have benefit, leveraging existing collaborations among the National Consortium of Parkinson's Disease providers in VA. This study will also provide the opportunity and mentorship for a nurse researcher in VA to develop into an independent investigator, capable of leading future research to translate evidence into practice for PD and other chronic neurological diseases.

描述（由申请人提供）： VHA 超过 40,000 名退伍军人被诊断患有帕金森病 (PD)，这是一种慢性、使人衰弱的神经退行性疾病，随着时间的推移会产生更多症状，影响运动能力，并具有广泛的非运动功能障碍，包括睡眠障碍、抑郁和认知障碍广泛影响与健康相关的生活质量的身体、心理和社会层面。这项拟议研究的最终目标是测试护士主导的协调护理管理干预措施是否可以改善患有帕金森病的退伍军人的护理质量和健康状况，并确定其成本和实施的可行性。十年前成立了六个帕金森病研究、教育和临床中心 (PADRECC)，为退伍军人事务部提供帕金森病和其他运动障碍的专科护理，但专科医生数量不足，无法为所有患有帕金森病的退伍军人提供护理。为了解决这个问题，按照 VA 质量增强研究计划 (QUERI) 流程进行了一系列调查，以 1) 制定一套全面的循证指标来衡量 PD 护理的质量，2) 确定并记录在VA 护理与这些指标相关，3) 分析 PD 护理质量的变化以及与这些变化相关的因素。根据这项研究，与护理管理者一起重新设计交付系统，使用标准化评估工具和护理协调协议来解决患有帕金森病的退伍军人未得到满足的需求，并与这些退伍军人及其家人、提供者和社区合作伙伴合作管理帕金森病护理- 假设可以克服将基于证据的帕金森病护理指南转化为一般退伍军人事务部护理服务系统的已知障碍。在 VA 资助的一项即将完成的试点研究中，成立了一个由利益相关者组成的工作组，其中包括护士、医生、其他医疗保健学科和患者权益倡导者；工作组成员来自 VISN 22（南加州和内华达州）的 VA 设施网络，这些机构隶属于 VA 大洛杉矶医疗系统的 PADRECC，以及来自 PD 倡导团体。工作组就本 VISN 中用于衡量 PD 护理质量基准的广泛质量目标达成了共识，这些目标是根据先前制定的 PD 护理循证质量指标以及记录护理差距的先前研究而选择的。这些有针对性的质量目标反过来指导了PD退伍军人的开发和试点测试，以及随后完善的一套护理管理工具和实施护士主导的协调护理干预所需的详细临床方案。在这项拟议的研究中，这种新的护理模式将在参与试点研究的三个 VISN 22 VA 设施中实施，并将涉及来自工作组的 PD 护理临床冠军。然后，来自这些设施的 400 名患有帕金森病的退伍军人将被登记并以 1:1 的比例随机接受这种新的协调护理模式或常规护理。退伍军人将在基线和 18 个月内的 3 次随访中接受评估。主要研究成果是遵守已确定的质量目标；次要研究结果将包括与健康相关的生活质量、对护理质量的看法和自我效能。退伍军人将接受电话调查，并提取医疗记录来衡量这些结果。将进行成本分析，总结 VA 的计划成本，并检查随机分组之间是否存在成本抵消。还将对干预措施的实施程度以及潜在传播的障碍和促进因素进行定性评估。如果发现该干预措施具有益处，这些数据将提供新的知识，对于未来在退伍军人事务部传播这一干预措施至关重要，并利用退伍军人国家帕金森病提供者联盟之间的现有合作。这项研究还将为退伍军人事务部的一名护士研究员提供机会和指导，使其发展成为一名独立研究者，能够领导未来的研究，将证据转化为帕金森病和其他慢性神经系统疾病的实践。