Chronic Care Management Model Translation to Multimorbid Aging Adults at FQHCs

将慢性护理管理模式转化为 FQHC 的多病老年人

• 批准号: 8506930
• 负责人: Cindy Lou Corbett
• 金额: $ 37.39万
• 依托单位: WASHINGTON STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8506930
• 关键词: Academic Medical Centers; Acute; Admission activity; Adoption; Adult; Age; Age-Years; Aging; Attention; Caregivers; Caring; Chronic; Chronic Care; Chronic Disease; Clinical Trials; Clinical Trials Design; Collaborations; Communities; Computer software; Control Groups; Data; Education; Effectiveness; Federally Qualified Health Center; Goals; Growth; Health; Health Status; Healthcare; Home Care Services; Home environment; Home visitation; Hospitalization; Hospitals; House Call; Informed Consent; Institutional Review Boards; Intervention; Knowledge; Life; Medical Care Team; Metric; Mission; Modeling; Outcome; Participant; Patient Care; Patient-Centered Care; Patients; Prevalence; Preventive; Public Health; Quality of Care; Quality of life; Randomized; Recording of previous events; Research; Resources; Rural; Self Management; Services; Social Work; Social Workers; Staging; Structure; System; Techniques; Testing; Time; Translating; Translational Research; Translations; Visit; Washington; Work; Writing; arm; base; blind; care delivery; care seeking; cost; cost effective; cost effectiveness; empowered; evidence base; health care delivery; health related quality of life; high risk; improved; innovation; meetings; member; multiple chronic conditions; patient home care; patient oriented; primary outcome; programs; public health relevance; satisfaction

DESCRIPTION (provided by applicant): Despite high chronic care costs, patient care satisfaction, education, activation and outcomes are sub-optimal. Translational research to test innovative models that will empower high risk patients to manage chronic conditions in collaboration with their health homes while improving care outcomes is critically needed because of the growing prevalence of aging adults with multiple chronic conditions (i.e., multimorbidity), and the fiscal urgency for higher care quality without increased costs. The main objective of this application is to translate the Chronic Care Intervention (CCI) to aging adults with multimorbidity that have a high baseline rate of acute care utilization. To this end, the following specific aims will be achieved: 1) Evaluate the impact of the Chronic Care Intervention (CCI) on health activation among aging adults with multimorbidity and high baseline acute care use who have a Federally Qualified Health Center (FQHC) home; 2) Evaluate the impact of the CCI on acute care utilization among aging adults with multimorbidity and high baseline acute care use who have a FQHC home; and 3) Evaluate the cost-effectiveness of the CCI among aging adults with multimorbidity and high baseline acute care use who have a FQHC home. The CCI will be tested using a randomized, single- blind clinical trial design. Study entry criteria include FQHC home patients over 45 years of age (n = 300) who live in the community and have at least two chronic conditions. After IRB-approved written informed consent, participants will be placed into one of the two groups using a randomization software program that will stratify each participant across potential confounders. The intervention will be implemented by a RN and Social Worker team to provide intervention-arm participants with self-management support and care coordination such that participants are engaged as partners with their health team. Attention control intervention will be implemented by a Social Services Paraprofessional Aide who will provide control participants with information about available community resources for assistance in the home if they self-identify a need for such support. Participants and/or famil members/caregivers could then contact the community resource if they so desired. All participant will be assessed on pertinent outcomes (health activation scores, self-rated health status, and health-related quality of life) at baseline, 3, 6, 9, and 12 months. Acute care utilization data will be assessed at 3, 6, 9 and 12 months. The primary outcome for Specific Aim 1 will be participant activation stage. The main outcomes for Specific Aim 2 will be days to first ED visit or hospitalization and total number of ED visits and hospitalizations. The outcome for Specific Aim 3 will be health-related quality of life. To evaluate the aims, random-effects regression techniques will be performed to identify group differences on 1) patient activation over time, 2) ED visits and rehospitalizations, and 3) health-related quality of life over time. Th expected outcomes of the experimental intervention are that participant activation, health status ratings, and health-related quality of life will increase and that ED visits, hospital admissions, and costs will be reduced. This contribution is significant because it will advance knowledge about community partnerships and best practices to enhance the ability of health homes to provide patient-centered team-based care in a manner that engages activated and informed patients and results in more effective use of health care resources.

描述（由申请人提供）：尽管慢性护理成本较高，但患者护理满意度、教育、激活和结果均未达到最佳状态。由于患有多种慢性病（即多发病）的老年人患病率不断增加，迫切需要进行转化研究来测试创新模型，使高风险患者能够与其健康之家合作管理慢性病，同时改善护理结果。迫切需要在不增加成本的情况下提高护理质量。该应用程序的主要目标是将慢性护理干预 (CCI) 应用于具有较高急性护理利用率基线的患有多种疾病的老年人。为此，将实现以下具体目标： 1) 评估慢性护理干预 (CCI) 对拥有联邦合格健康中心 (FQHC) 住宅且患有多种疾病和高基线急性护理使用的老年人的健康激活的影响; 2) 评估 CCI 对患有多种疾病且拥有 FQHC 之家的高基线急症护理使用的老年人的急症护理利用的影响； 3) 评估 CCI 对于患有多种疾病且拥有 FQHC 之家并使用高基线急症护理的老年人的成本效益。 CCI 将使用随机、单盲临床试验设计进行测试。研究纳入标准包括 45 岁以上、居住在社区且患有至少两种慢性病的 FQHC 家庭患者 (n = 300)。在 IRB 批准书面知情同意书后，参与者将使用随机化软件程序被分为两组中的一组，该程序将根据潜在的混杂因素对每个参与者进行分层。干预措施将由注册护士和社会工作者团队实施，为干预组参与者提供自我管理支持和护理协调，使参与者成为其健康团队的合作伙伴。注意力控制干预将由社会服务专业辅助助理实施，如果控制参与者自我确定需要此类支持，他将为控制参与者提供有关可用社区资源的信息，以在家庭中提供帮助。如果参与者和/或家庭成员/护理人员愿意，则可以联系社区资源。所有参与者都将在基线、3、6、9 和 12 个月时接受相关结果（健康激活评分、自评健康状况和健康相关生活质量）的评估。急性护理利用数据将在第 3、6、9 和 12 个月时进行评估。具体目标 1 的主要成果将是参与者激活阶段。具体目标 2 的主要结果是距首次急诊就诊或住院的天数以及急诊就诊和住院的总数。具体目标 3 的结果将是与健康相关的生活质量。为了评估目标，将采用随机效应回归技术来识别 1) 随着时间的推移患者激活情况、2) 急诊就诊和再住院以及 3) 随着时间的推移与健康相关的生活质量的组间差异。实验干预的预期结果是参与者的积极性、健康状况评级和健康相关的生活质量将提高，急诊就诊、住院和费用将减少。这一贡献意义重大，因为它将增进对社区合作伙伴关系和最佳实践的了解，从而增强健康之家的能力，以让患者积极参与、知情的方式提供以患者为中心的团队护理，并更有效地利用医疗保健资源。